MEDICARE: MISS PATRICIA ANN HEIRTZLER FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	AP138551	TX
2	363L00000X	Nurse Practitioner	AP138551	TX

General Provider Information

NPI Number	:	1043790785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PATRICIA ANN HEIRTZLER FNP-C

Provider Business Mailing Address
First Line	:	689 6TH ST
Second Line	:
City	:	SOUR LAKE
State	:	TX
Zip	:	77659-1870
Country	:	US
Telephone Number	:	406-287-4100
Fax Number	:	409-287-4105

Provider Business Practice Location Address
First Line	:	689 6TH ST
Second Line	:
City	:	SOUR LAKE
State	:	TX
Zip	:	77659-1870
Country	:	US
Telephone Number	:	409-287-4100
Fax Number	:	409-287-4105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	04/08/2026

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Directions to “ MISS PATRICIA ANN HEIRTZLER FNP-C” Practice Location

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