MEDICARE: MRS. HALEY HEATHER ATP

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	247200000X	Other Technician	100138	TX

General Provider Information

NPI Number	:	1477346138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HALEY HEATHER ATP

Provider Business Mailing Address
First Line	:	590 CHERYL ST
Second Line	:
City	:	PILOT POINT
State	:	TX
Zip	:	76258-1547
Country	:	US
Telephone Number	:	870-692-1747
Fax Number	:

Provider Business Practice Location Address
First Line	:	4413 TYLER PARK DR STE A
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-3123
Country	:	US
Telephone Number	:	903-592-3300
Fax Number	:	888-633-7575

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

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	05/27/2025

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Directions to “ MRS. HALEY HEATHER ATP” Practice Location

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