MEDICARE: HEATHER FOSTER HEALTH SERVICES LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1386415479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEATHER FOSTER HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 6016
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73153-0016
Country	:	US
Telephone Number	:	405-632-8658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 SW 89TH ST STE D100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6378
Country	:	US
Telephone Number	:	405-546-7888
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	HEATHER DAWN FOSTER
Credential	:	FNP-DNP, APRN-C
Telephone Number	:	405-632-8658

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	01/09/2024

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