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General NPI Number Information
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NPI Number | 1689018806
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Entity Type | Individual
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Provider Name | BRYAN KEITH HEISKELL EP T, CNIMS
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Gender | Male
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 712 N 77 SUNSHINESTRIP STE 23
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City | HARLINGEN
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State | TX
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Zip | 78550-8897
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Country | US
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Telephone | 956-216-7540
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Fax | 956-216-7542
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Provider Business Mailing Address
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Address Line | PO BOX 532620
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City | HARLINGEN
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State | TX
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Zip | 78553-2620
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Country | US
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Telephone | 956-216-7540
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Fax | 956-216-7542
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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 | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number | CNS4430
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License Number State | TX
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