Provider Demographics
NPI:1295275014
Name:ANDERSON, HEIDI (RN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 E SKELLY DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6106
Mailing Address - Country:US
Mailing Address - Phone:918-289-6062
Mailing Address - Fax:
Practice Address - Street 1:1340 S WALDRON RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2556
Practice Address - Country:US
Practice Address - Phone:479-452-5040
Practice Address - Fax:479-452-5047
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR032815163WP0808X
OKR0049908163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health