MEDICARE: HEATHER J WELLMAN PA-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	363A00000X	Physician Assistant	PA04349	TX
2	363AM0700X	Medical Physician Assistant	PA04349	TX
3	363AS0400X	Surgical Physician Assistant	PA04349	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5840300001	OTHER	TX	MEDICARE DME
3	TXB120923	OTHER	TX	MEDICARE PART B - EFFECT 02/01/2011
5	P00954369	OTHER	TX	RAILROAD MEDICARE
6	714812	OTHER	TX	MEDICARE PART B
8	P00684449	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8Y1402	OTHER	TX	BCBS TEXAS NUMBER
4	1699746594	OTHER	TX	NPI
7	835N05	OTHER	TX	BCBS TX 02/01/2011

General Provider Information

NPI Number	:	1699746594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER J WELLMAN PA-C

Provider Business Mailing Address
First Line	:	2425 HIGHWAY 121
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-5011
Country	:	US
Telephone Number	:	817-540-4477
Fax Number	:	817-540-5633

Provider Business Practice Location Address
First Line	:	2900 N I 35 STE 200
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-5144
Country	:	US
Telephone Number	:	940-323-3400
Fax Number	:	940-323-3410

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	12/03/2025

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Directions to “ HEATHER J WELLMAN PA-C” Practice Location

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