Individual
HEATHER MARIE DICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2000
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA07875
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
304325901
—
TX
01
—
885N19
BCBS
TX
Enumeration date
08/01/2012
Last updated
11/27/2012
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