Provider Demographics
NPI:1699173062
Name:HEERSCHAP, AUSTIN E
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:E
Last Name:HEERSCHAP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AUSTIN
Other - Middle Name:E
Other - Last Name:HEERSCHAP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:5000 LONG PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2783
Mailing Address - Country:US
Mailing Address - Phone:972-420-1776
Mailing Address - Fax:972-221-8685
Practice Address - Street 1:5000 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2783
Practice Address - Country:US
Practice Address - Phone:972-420-1776
Practice Address - Fax:972-221-8685
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09386363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA09386OtherPA LICENSE
TX1477830677OtherNPI TYPE 2 GROUP EMPLOYER
00317YOtherMEDICARE PTAN EMPLOYER
TX1588749766OtherNPI TYPE 2 GROUP EMPLOYER
TX385783YK02OtherMEDICARE PTAN INDIVIDUAL