Provider Demographics
NPI:1699746594
Name:WELLMAN, HEATHER J (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5011
Mailing Address - Country:US
Mailing Address - Phone:817-540-4477
Mailing Address - Fax:817-540-5633
Practice Address - Street 1:3537 S I 35 E STE 316
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6870
Practice Address - Country:US
Practice Address - Phone:940-205-4229
Practice Address - Fax:940-243-3362
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04349363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y1402OtherBCBS TEXAS NUMBER
TX5840300001OtherMEDICARE DME
TXTXB120923OtherMEDICARE PART B - EFFECT 02/01/2011
TX1699746594OtherNPI
TXP00954369OtherRAILROAD MEDICARE
TX714812OtherMEDICARE PART B
TX835N05OtherBCBS TX 02/01/2011
TXP00684449OtherRAILROAD MEDICARE
TX8Y1402OtherBCBS TEXAS NUMBER