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General NPI Number Information
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NPI Number | 1376148072
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Entity Type | Individual
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Provider Name | JEANIE K HEIDELBERG PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 4333 HWY 16 S STE 400
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City | BANDERA
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State | TX
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Zip | 78003-5167
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Country | US
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Telephone | 830-264-8210
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Fax |
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Provider Business Mailing Address
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Address Line | 4333 HWY 16 S STE 400
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City | BANDERA
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State | TX
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Zip | 78003-5167
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Country | US
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Telephone | 830-264-8210
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1020420
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License Number State | TX
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