Provider Demographics
NPI:1952296600
Name:HEFFERTON, ELISE MICHELLE (RN,BSN)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:MICHELLE
Last Name:HEFFERTON
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 GROVE CREST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-1904
Mailing Address - Country:US
Mailing Address - Phone:512-330-4433
Mailing Address - Fax:
Practice Address - Street 1:6908 GROVE CREST DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-1904
Practice Address - Country:US
Practice Address - Phone:512-330-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX634732163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care