Provider Demographics
NPI:1598857419
Name:KUKLINSKI, HEATHER COLLIGAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:COLLIGAN
Last Name:KUKLINSKI
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3400 W TECUMSEH RD
Mailing Address - Street 2:STE 101
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1810
Mailing Address - Country:US
Mailing Address - Phone:405-360-6764
Mailing Address - Fax:405-360-6769
Practice Address - Street 1:608 NW 9TH ST STE 6000
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1041
Practice Address - Country:US
Practice Address - Phone:405-360-6764
Practice Address - Fax:405-360-6769
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2018-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1405363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243527301Medicare ID - Type Unspecified
OKQ52285Medicare UPIN