Healthcare Provider Details

I. General information

NPI: 1457103392
Provider Name (Legal Business Name): MR. HARVEY LESTER HUEBOTTER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W WHEATLAND RD
DALLAS TX
75237-3460
US

IV. Provider business mailing address

5407 FALCON WOOD CT
ARLINGTON TX
76016-1635
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-7777
  • Fax:
Mailing address:
  • Phone: 817-938-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1155991
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: