Provider Demographics
NPI: | 1528562071 |
---|---|
Name: | COOK, HEIDI N (APN) |
Entity Type: | Individual |
Prefix: | |
First Name: | HEIDI |
Middle Name: | N |
Last Name: | COOK |
Suffix: | |
Gender: | F |
Credentials: | APN |
Other - Prefix: | |
Other - First Name: | HEIDI |
Other - Middle Name: | N |
Other - Last Name: | CHAMBERLAIN |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | APN |
Mailing Address - Street 1: | 6600 S YALE AVE STE 1400 |
Mailing Address - Street 2: | |
Mailing Address - City: | TULSA |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74136-3331 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6585 S YALE AVE STE 720 |
Practice Address - Street 2: | |
Practice Address - City: | TULSA |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74136-8320 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-502-5930 |
Practice Address - Fax: | 918-502-5935 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-03-20 |
Last Update Date: | 2022-07-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 200880 | 364SG0600X, 363LG0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
Yes | 364SG0600X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Gerontology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OK | 200957830A | Medicaid |