Provider Demographics
NPI:1336243351
Name:SKRIVANEK, HEATHER HOLLAND (PHD, CPNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:HOLLAND
Last Name:SKRIVANEK
Suffix:
Gender:F
Credentials:PHD, CPNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 N KIMBALL AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6879
Mailing Address - Country:US
Mailing Address - Phone:817-899-8485
Mailing Address - Fax:817-977-9025
Practice Address - Street 1:560 N KIMBALL AVE STE 130
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6879
Practice Address - Country:US
Practice Address - Phone:817-899-8485
Practice Address - Fax:817-977-9025
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113941363LP0200X
TX113941363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics