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General NPI Number Information
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NPI Number | 1174894828
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Entity Type | Individual
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Provider Name | JENNEN LEE HEATHMAN RN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/22/2017
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Provider Practice Location Address
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Address Line | 21703 KINGSLAND BLVD STE 101
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City | KATY
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State | TX
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Zip | 77450-2521
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Country | US
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Telephone | 281-944-9442
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Fax | 832-321-3012
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Provider Business Mailing Address
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Address Line | 21703 KINGSLAND BLVD STE 101
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City | KATY
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State | TX
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Zip | 77450-2521
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Country | US
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Telephone | 281-944-9442
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Fax | 832-321-3012
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 646173
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License Number State | TX
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