Provider Demographics
NPI:1467288761
Name:KILLINGSWORTH, HEATHER RENEE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:KILLINGSWORTH
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 1:205 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-3021
Mailing Address - Country:US
Mailing Address - Phone:918-470-0144
Mailing Address - Fax:
Practice Address - Street 1:205 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-3021
Practice Address - Country:US
Practice Address - Phone:918-470-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator