Healthcare Provider Details

I. General information

NPI: 1023668100
Provider Name (Legal Business Name): HNPIOM PRO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3526 LAKEVIEW PKWY STE B257
ROWLETT TX
75088-4176
US

IV. Provider business mailing address

3526 LAKEVIEW PKWY STE B257
ROWLETT TX
75088-4176
US

V. Phone/Fax

Practice location:
  • Phone: 972-412-5299
  • Fax: 469-453-3374
Mailing address:
  • Phone: 972-412-5299
  • Fax: 469-453-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CAROL HEDTKE
Title or Position: SOLE MEMBER
Credential: NP
Phone: 972-412-5299