Provider Demographics
NPI:1851669279
Name:MOUNT, HEATHER RAE (CRNA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAE
Last Name:MOUNT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RAE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:404 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6765
Mailing Address - Country:US
Mailing Address - Phone:832-493-3688
Mailing Address - Fax:
Practice Address - Street 1:17510 W GRAND PKWY S STE 200
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2647
Practice Address - Country:US
Practice Address - Phone:281-238-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121515367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered