MEDICARE: KANDISS ELIZABETH HEARN APRN, 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	363L00000X	Nurse Practitioner	856493	TX

General Provider Information

NPI Number	:	1336774405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANDISS ELIZABETH HEARN APRN, FNP-C

Provider Business Mailing Address
First Line	:	3535 N FOURTH ST STE 400
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75605-0038
Country	:	US
Telephone Number	:	903-757-3881
Fax Number	:

Provider Business Practice Location Address
First Line	:	2365 THREE LAKES PKWY
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703
Country	:	US
Telephone Number	:	903-991-4569
Fax Number	:

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

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	12/08/2025

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