MEDICARE: DR. HETTA ATKINS ACNP

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	363LA2100X	Acute Care Nurse Practitioner	683687	TX
2	363L00000X	Nurse Practitioner	AP122325	TX

General Provider Information

NPI Number	:	1881945830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HETTA ATKINS ACNP

Provider Business Mailing Address
First Line	:	4522 FREDERICKSBURG RD STE A14
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-6595
Country	:	US
Telephone Number	:	210-733-3005
Fax Number	:

Provider Business Practice Location Address
First Line	:	4522 FREDERICKSBURG RD STE A14
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-6595
Country	:	US
Telephone Number	:	210-733-3005
Fax Number	:	210-733-3001

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

Provider Enumeration Date	:	09/29/2012
Last Update Date	:	10/26/2023

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