Provider Demographics
NPI:1326308792
Name:HEAROD, KELSEY RENEA
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:RENEA
Last Name:HEAROD
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 1:872 STATE HIGHWAY 113
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-8480
Mailing Address - Country:US
Mailing Address - Phone:918-470-3126
Mailing Address - Fax:
Practice Address - Street 1:872 STATE HIGHWAY 113
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-8480
Practice Address - Country:US
Practice Address - Phone:918-470-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator