Provider Demographics
NPI:1437428554
Name:LITTRELL, HEATHER LOUISE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LOUISE
Last Name:LITTRELL
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 1:19428 HIGHWAY 32
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-8099
Mailing Address - Country:US
Mailing Address - Phone:580-236-8203
Mailing Address - Fax:
Practice Address - Street 1:209 E WILSON ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-2200
Practice Address - Country:US
Practice Address - Phone:580-371-3019
Practice Address - Fax:580-371-0138
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator