Healthcare Provider Details

I. General information

NPI: 1467841676
Provider Name (Legal Business Name): HEATHER STIPPEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 39TH ST
GROVES TX
77619-2911
US

IV. Provider business mailing address

5301 39TH ST
GROVES TX
77619-2911
US

V. Phone/Fax

Practice location:
  • Phone: 409-962-4272
  • Fax: 409-962-2451
Mailing address:
  • Phone: 409-962-4272
  • Fax: 409-962-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09546
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: