Provider Demographics
NPI:1336253673
Name:DAWSON, HEIDI E (PA-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:E
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:E
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:550 S PEORIA AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-3820
Mailing Address - Country:US
Mailing Address - Phone:918-588-1900
Mailing Address - Fax:918-582-6405
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-392-7000
Practice Address - Fax:918-392-7013
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK400138Medicare PIN