MEDICARE: HEATHER SEYBOLDT-RUPAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	APRN.CNP.0042466	OH
2	363LG0600X	Gerontology Nurse Practitioner	APRN.CNP.0042466	OH
3	363LP2300X	Primary Care Nurse Practitioner	APRN.CNP.0042466	OH

General Provider Information

NPI Number	:	1043140221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER SEYBOLDT-RUPAR

Provider Business Mailing Address
First Line	:	PO BOX 269084
Second Line	:	DEPT 1102
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126
Country	:	US
Telephone Number	:	731-394-1145
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 PARRISH RD
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-1178
Country	:	US
Telephone Number	:	731-234-8120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	06/18/2026

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Directions to “ HEATHER SEYBOLDT-RUPAR ” Practice Location

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