Provider Demographics
NPI:1992134829
Name:BANGERTER, HEATHER SUE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUE
Last Name:BANGERTER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-1470
Mailing Address - Country:US
Mailing Address - Phone:830-773-8917
Mailing Address - Fax:830-773-1892
Practice Address - Street 1:2209 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-8007
Practice Address - Country:US
Practice Address - Phone:830-775-1272
Practice Address - Fax:855-217-1086
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX63891OtherTEXAS BOARD OF NURSING
TXF0516679OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS - CERTIFICATION BOARD
TX1074929OtherTEXAS BOARD OF NURSING