Healthcare Provider Details

I. General information

NPI: 1629647706
Provider Name (Legal Business Name): MOLLY DEE HEATH MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4681 COLLEGE PARK DR
ROUND ROCK TX
78665-1526
US

IV. Provider business mailing address

5224 75TH ST STE D
LUBBOCK TX
79424-2525
US

V. Phone/Fax

Practice location:
  • Phone: 512-671-1100
  • Fax:
Mailing address:
  • Phone: 806-712-1096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216295
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1048157
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: