Provider Demographics
NPI:1619961885
Name:GEIS, HEATHER K (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:GEIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2816 NW 57TH ST
Mailing Address - Street 2:104
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7045
Mailing Address - Country:US
Mailing Address - Phone:405-848-7882
Mailing Address - Fax:405-848-7818
Practice Address - Street 1:1625 GREENBRIAR PL
Practice Address - Street 2:#300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7645
Practice Address - Country:US
Practice Address - Phone:405-692-4000
Practice Address - Fax:405-692-4001
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK157102084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100107830AMedicaid
F91620Medicare UPIN