Provider Demographics
NPI:1356773444
Name:RICH, HEATHER B (NP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:B
Last Name:RICH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5806 PENROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5520
Mailing Address - Country:US
Mailing Address - Phone:817-635-6363
Mailing Address - Fax:
Practice Address - Street 1:1806 W PLEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4530
Practice Address - Country:US
Practice Address - Phone:817-635-6363
Practice Address - Fax:817-635-6362
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX835436363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health