Provider Demographics
NPI:1932478229
Name:SCRANTON, HEATHER MICHELLE (PA-C, RD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHELLE
Last Name:SCRANTON
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MICHELLE
Other - Last Name:SCHULZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, RD
Mailing Address - Street 1:1110 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1110 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE 502
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5468
Practice Address - Country:US
Practice Address - Phone:512-474-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX979151133V00000X
TXPA07423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered