Provider Demographics
NPI:1508909854
Name:HEFLEY, AMY E
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:HEFLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:RITENOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 W ELMIRA PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0889
Mailing Address - Country:US
Mailing Address - Phone:918-249-0004
Mailing Address - Fax:918-249-0004
Practice Address - Street 1:1300 W ELMIRA PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-0889
Practice Address - Country:US
Practice Address - Phone:918-249-0004
Practice Address - Fax:918-249-0004
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
OK89577363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant