Provider Demographics
NPI:1245013804
Name:MISKA, HEATHER FAYE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:FAYE
Last Name:MISKA
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 1:622 MCLISH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4748
Mailing Address - Country:US
Mailing Address - Phone:541-953-9511
Mailing Address - Fax:
Practice Address - Street 1:622 MCLISH ST APT 1
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4748
Practice Address - Country:US
Practice Address - Phone:541-953-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR7564217OtherDMV