Healthcare Provider Details

I. General information

NPI: 1699002253
Provider Name (Legal Business Name): HEIDY REBEKAH BRILLHART APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 MORTON STREET
ELKHART KS
67950
US

IV. Provider business mailing address

HC 2 BOX 6
KEYES OK
73947-9609
US

V. Phone/Fax

Practice location:
  • Phone: 866-498-7922
  • Fax: 620-491-9009
Mailing address:
  • Phone: 866-498-7922
  • Fax: 620-491-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-76427-042
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76427-042
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0072633
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: