Provider Demographics
NPI:1093172272
Name:HEISEY, MATTHEW (ARNP-CNP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HEISEY
Suffix:
Gender:
Credentials:ARNP-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 NORWOOD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-5235
Mailing Address - Country:US
Mailing Address - Phone:682-503-4256
Mailing Address - Fax:682-503-4251
Practice Address - Street 1:1312 NORWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5235
Practice Address - Country:US
Practice Address - Phone:682-503-4256
Practice Address - Fax:682-503-4251
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0106028163W00000X
TX1191282163W00000X
OK106028363LF0000X
FL9487535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse