| Doctor Name: | HEATHER M DALLAS |
| NPI Number: | 1033456744 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 808032 |
| Business Practice Address: | 225 E Beauregard Ave San Angelo, TX - 769035920 |
| Business Phone Number: | 3254812287 |
| Business Fax Number: | |
| Mailing Address: | Po Box 22000, SAN ANGELO |
| State: | TX |
| Postal Code: | 769027200 |
| Phone Number: | 3256581511 |
| Fax Number: | 3254812165 |
| NPI Enumeration Date: | 01/15/2013 |
| NPI Last Update Date: | 01/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 808032 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |