Provider Demographics
NPI:1780447623
Name:NEEL, HEATHER MARIE (RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:NEEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7952 FM 512
Mailing Address - Street 2:
Mailing Address - City:WOLFE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75496-2486
Mailing Address - Country:US
Mailing Address - Phone:330-692-3168
Mailing Address - Fax:
Practice Address - Street 1:4501 JOE RAMSEY BLVD E STE 130
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7830
Practice Address - Country:US
Practice Address - Phone:903-201-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152695363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner