Active NPI
Jennen Lee Heathman, RN, NP-C
- Adult Health Nurse Practitioner
- Katy, TX
National Provider Identifier
1174894828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 646173
- Practice address
- 21703 Kingsland Blvd Ste 101
Katy, TX 77450-2521 - Phone
- (281) 944-9442
- Fax
- (832) 321-3012
- NPI assigned
- Jan 25, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 646173 | TX | Primary |
Addresses
Primary practice location
21703 Kingsland Blvd Ste 101
Katy, TX 77450-2521
Mailing address
21703 Kingsland Blvd Ste 101
Katy, TX 77450-2521
Phone (281) 944-9442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Collaborative Geriatrics Inc | Adult Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485043200000",
"number": "1174894828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21703 KINGSLAND BLVD STE 101",
"city": "KATY",
"state": "TX",
"postal_code": "774502521",
"telephone_number": "281-944-9442",
"fax_number": "832-321-3012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21703 KINGSLAND BLVD STE 101",
"city": "KATY",
"state": "TX",
"postal_code": "774502521",
"telephone_number": "281-944-9442",
"fax_number": "832-321-3012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEATHMAN",
"first_name": "JENNEN",
"middle_name": "LEE",
"credential": "RN, NP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-25",
"last_updated": "2017-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "TX",
"license": "646173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Katy, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.