Provider Demographics
NPI:1134466857
Name:HEIM, KAYLEE DENISE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:DENISE
Last Name:HEIM
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 891625
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189
Mailing Address - Country:US
Mailing Address - Phone:405-757-7818
Mailing Address - Fax:405-936-1122
Practice Address - Street 1:3110 SW 89TH ST
Practice Address - Street 2:SUITE 200B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159
Practice Address - Country:US
Practice Address - Phone:405-757-7818
Practice Address - Fax:405-936-1122
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0097185363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics