Provider Demographics
NPI:1497589873
Name:HEGGINS, GWENDOLYN DENISE (NP)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:DENISE
Last Name:HEGGINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N DAIRY ASHFORD RD APT 566
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-3049
Mailing Address - Country:US
Mailing Address - Phone:832-475-2244
Mailing Address - Fax:
Practice Address - Street 1:455 PARK GROVE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1572
Practice Address - Country:US
Practice Address - Phone:832-353-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168318363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health