Provider Demographics
NPI:1124780556
Name:HEADRICK, TIFFANY KAY (NP-C)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:KAY
Last Name:HEADRICK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 STATE HIGHWAY 16 S
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-4830
Mailing Address - Country:US
Mailing Address - Phone:830-796-7713
Mailing Address - Fax:830-796-7744
Practice Address - Street 1:1050 HWY 16 S
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-4830
Practice Address - Country:US
Practice Address - Phone:830-426-6299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily