Healthcare Provider Details

I. General information

NPI: 1376477646
Provider Name (Legal Business Name): MICHELLE DUVALL HEATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 WALNUT HILL DR
LONGVIEW TX
75605-5052
US

IV. Provider business mailing address

10 HUNTINGTON ST
LONGVIEW TX
75601-3500
US

V. Phone/Fax

Practice location:
  • Phone: 903-291-6300
  • Fax: 903-291-6305
Mailing address:
  • Phone: 903-276-6893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51582
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: