MEDICARE: MARY JOAN HEINLY PA

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	363A00000X	Physician Assistant	PA01765	TX

General Provider Information

NPI Number	:	1518168103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JOAN HEINLY PA

Provider Business Mailing Address
First Line	:	211 HIGHLAND CROSS DR STE 275
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-1741
Country	:	US
Telephone Number	:	281-784-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 HIGHLAND CROSS DR STE 275
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-1741
Country	:	US
Telephone Number	:	281-784-1500
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/24/2010

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