Provider Demographics
NPI:1700647310
Name:SIMPLE BLESSINGS PEDIATRICS AND FUNCTIONAL MEDICINE, LLC
Entity Type:Organization
Organization Name:SIMPLE BLESSINGS PEDIATRICS AND FUNCTIONAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HASARA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CPNP-PC
Authorized Official - Phone:888-401-2244
Mailing Address - Street 1:12235 LITTLE BLUE HERON LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1689
Mailing Address - Country:US
Mailing Address - Phone:888-401-2244
Mailing Address - Fax:
Practice Address - Street 1:12235 LITTLE BLUE HERON LN
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1689
Practice Address - Country:US
Practice Address - Phone:888-401-2244
Practice Address - Fax:844-328-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty