Healthcare Provider Details

I. General information

NPI: 1700192697
Provider Name (Legal Business Name): HEATHER FAYE CLINTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E JEFFERSON AVE
WHITNEY TX
76692-2398
US

IV. Provider business mailing address

202 E JEFFERSON AVE
WHITNEY TX
76692-2398
US

V. Phone/Fax

Practice location:
  • Phone: 254-694-2221
  • Fax: 254-694-9978
Mailing address:
  • Phone: 254-694-2221
  • Fax: 254-694-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number677845
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: