Provider Demographics
NPI:1689219321
Name:BEARD, HEATHER BLANE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:BLANE
Last Name:BEARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 S CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-5301
Mailing Address - Country:US
Mailing Address - Phone:405-614-5736
Mailing Address - Fax:
Practice Address - Street 1:423 S CAPITOL ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-5301
Practice Address - Country:US
Practice Address - Phone:405-614-5736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist