Individual
HEIDI M MANSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 MEDICAL DR, LAKE JACKSON, TX 77566-5674
(979) 297-4411
Mailing address
1717 MAIN ST, STE 5200, DALLAS, TX 75201-4612
(214) 712-2000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
654373
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396009015
TRICARE
TX
05
—
305464503
—
TX
01
—
881N41
BCBS
TX
Enumeration date
06/27/2012
Last updated
06/25/2013
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