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General NPI Number Information
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NPI Number | 1700647310
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Entity Type | Organization
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Legal Business Name | SIMPLE BLESSINGS PEDIATRICS & FUNCTIONAL MEDICINE, LLC
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 12235 LITTLE BLUE HERON LN
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City | CONROE
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State | TX
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Zip | 77304-1689
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Country | US
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Telephone | 936-236-9147
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Fax |
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Provider Business Mailing Address
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Address Line | 12235 LITTLE BLUE HERON LN
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City | CONROE
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State | TX
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Zip | 77304-1689
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Country | US
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Telephone | 936-236-9147
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Fax | 936-244-4513
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER LEE HASARA
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Credential | FNP-C, CPNP-PC
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Telephone | 936-236-9147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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