Healthcare Provider Details

I. General information

NPI: 1417999848
Provider Name (Legal Business Name): CAROL J HEDTKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 CHARLOTTE ST SUITE 102
DENTON TX
76201-3301
US

IV. Provider business mailing address

2535 CHARLOTTE ST SUITE 102
DENTON TX
76201-3301
US

V. Phone/Fax

Practice location:
  • Phone: 940-387-7300
  • Fax: 940-387-1848
Mailing address:
  • Phone: 940-387-7300
  • Fax: 940-387-1848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number675701
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: