Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 249415 | TX |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 249415 | TX |
NPI | 1104136316 |
---|---|
Provider Name | Stephanie M Heflin |
First Address | Houston, TX 77024-1143 |
Second Address | Houston, TX 77024-1143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2010 |
Last Update Date | 15/06/2011 |