Provider Demographics
NPI:1336774405
Name:HEARN, KANDISS ELIZABETH (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KANDISS
Middle Name:ELIZABETH
Last Name:HEARN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:KANDISS
Other - Middle Name:
Other - Last Name:BRASWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 E SOUTHEAST LOOP
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:903-531-2850
Mailing Address - Fax:
Practice Address - Street 1:909 E SE LOOP 323 STE 110
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9675
Practice Address - Country:US
Practice Address - Phone:903-531-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX856493363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program