Provider Demographics
NPI:1053061457
Name:NELMS, HEATHER RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:NELMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16747 COUNTY ROAD 3547
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-7946
Mailing Address - Country:US
Mailing Address - Phone:918-282-6234
Mailing Address - Fax:
Practice Address - Street 1:120 N FORREST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:OK
Practice Address - Zip Code:74872-4652
Practice Address - Country:US
Practice Address - Phone:580-759-0022
Practice Address - Fax:580-759-2177
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207407363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health