Provider Demographics
NPI:1073080594
Name:CRITES, HEATHER (AGAGCNP-BC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CRITES
Suffix:
Gender:
Credentials:AGAGCNP-BC
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:CRITES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:
Practice Address - Street 1:20405 STATE HIGHWAY 249 STE 325
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2893
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPAN2816363LA2100X
TN37731363LA2100X
MO2024050244363LA2100X
IL041581955363LA2100X
AL3-002010363LA2100X
COC-APN.0103173-C-NP363LA2100X
OH0038017363LA2100X
TXAP139279363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073080594Medicaid
TX8RG692OtherBCBS