Active NPI
Heather Marie Dick, PA
- Physician Assistant
- Fort Worth, TX
National Provider Identifier
1851647481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA07875
- Practice address
- 855 Montgomery St
Fort Worth, TX 76107-2553 - Phone
- (817) 735-2000
- NPI assigned
- Aug 1, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA07875 | TX | Primary |
Addresses
Primary practice location
855 Montgomery St
Fort Worth, TX 76107-2553
Mailing address
PO Box 99335
Fort Worth, TX 76199-0335
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 885N19 | Other | TX | BCBS |
| 304325901 | Medicaid | TX |
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
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353974400000",
"number": "1851647481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 99335",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761990335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "855 MONTGOMERY ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761072553",
"telephone_number": "817-735-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICK",
"first_name": "HEATHER",
"middle_name": "MARIE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-01",
"last_updated": "2012-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA07875",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "885N19",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "304325901",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.