Provider Demographics
NPI:1902364516
Name:HEINE, KATHRYN MICHELLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MICHELLE
Last Name:HEINE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 FOUNDERS WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5435
Mailing Address - Country:US
Mailing Address - Phone:817-741-8355
Mailing Address - Fax:817-741-8365
Practice Address - Street 1:10900 FOUNDERS WAY STE 103
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5435
Practice Address - Country:US
Practice Address - Phone:817-741-8355
Practice Address - Fax:817-741-8365
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily