Provider Demographics
NPI:1073983961
Name:PRENTICE, HEATHER (ARNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:OK
Mailing Address - Zip Code:74825-0305
Mailing Address - Country:US
Mailing Address - Phone:580-857-2424
Mailing Address - Fax:580-857-2220
Practice Address - Street 1:202 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:OK
Practice Address - Zip Code:74825
Practice Address - Country:US
Practice Address - Phone:580-857-2424
Practice Address - Fax:580-857-2220
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86291163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice