Provider Demographics
NPI:1194001107
Name:KENDRICK, HEATHER RAE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAE
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RAE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18103 E 47TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-7413
Mailing Address - Country:US
Mailing Address - Phone:918-521-1938
Mailing Address - Fax:
Practice Address - Street 1:18103 E 47TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-7413
Practice Address - Country:US
Practice Address - Phone:918-521-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK83292367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered