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
StateLicense IDTaxonomies
OK200880364SG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200957830AMedicaid