Healthcare Provider Details

I. General information

NPI: 1700647310
Provider Name (Legal Business Name): SIMPLE BLESSINGS PEDIATRICS & FUNCTIONAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12235 LITTLE BLUE HERON LN
CONROE TX
77304-1689
US

IV. Provider business mailing address

12235 LITTLE BLUE HERON LN
CONROE TX
77304-1689
US

V. Phone/Fax

Practice location:
  • Phone: 936-236-9147
  • Fax:
Mailing address:
  • Phone: 936-236-9147
  • Fax: 936-244-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HEATHER LEE HASARA
Title or Position: OWNER
Credential: FNP-C, CPNP-PC
Phone: 936-236-9147