Provider Demographics
NPI:1699127951
Name:KLINE, HEATHER JO (FNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JO
Last Name:KLINE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7201
Mailing Address - Country:US
Mailing Address - Phone:214-645-4673
Mailing Address - Fax:
Practice Address - Street 1:505 S NOLEN DR
Practice Address - Street 2:STE A
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9167
Practice Address - Country:US
Practice Address - Phone:817-424-1525
Practice Address - Fax:817-424-3491
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131194363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8961NYOtherBLUE CROSS BLUE SHEILD
TX8961NYOtherBLUE CROSS BLUE SHEILD