Provider Demographics
NPI:1164035127
Name:FLORES, HEATHER DAWN
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W BREANNA ST
Mailing Address - Street 2:
Mailing Address - City:KIEFER
Mailing Address - State:OK
Mailing Address - Zip Code:74041-4521
Mailing Address - Country:US
Mailing Address - Phone:539-902-9366
Mailing Address - Fax:
Practice Address - Street 1:308 W BREANNA ST
Practice Address - Street 2:
Practice Address - City:KIEFER
Practice Address - State:OK
Practice Address - Zip Code:74041-4521
Practice Address - Country:US
Practice Address - Phone:539-302-9366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist