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Individual
DR. KRISTY D. HEATLY
Active
Individual
DR. KRISTY D. HEATLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L3678
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J21A
GROUP MEDICARE NUMBER
TX
01
—
094010801
GROUP MEDICAID NUMBER
TX
Enumeration date
03/27/2006
Last updated
01/24/2013
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