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General NPI Number Information
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NPI Number | 1164617627
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Entity Type | Organization
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Legal Business Name | KRISTY D. HEATLY, D.O., P.A.
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 1900 SCENIC DR SUITE 1128
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City | GEORGETOWN
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State | TX
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Zip | 78626-7724
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Country | US
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Telephone | 512-864-2911
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 SCENIC DR SUITE 1128
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City | GEORGETOWN
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State | TX
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Zip | 78626-7724
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTY D HEATLY
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Credential | D.O.
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Telephone | 512-864-2911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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