MEDICARE: HEATHER B RICH NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	835436	TX

General Provider Information

NPI Number	:	1356773444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER B RICH NP-C

Provider Business Mailing Address
First Line	:	5806 PENROSE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5520
Country	:	US
Telephone Number	:	817-635-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	1806 W PLEASANT RIDGE RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-4530
Country	:	US
Telephone Number	:	817-635-6363
Fax Number	:	817-635-6362

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	12/28/2015

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