Healthcare Provider Details

I. General information

NPI: 1649227125
Provider Name (Legal Business Name): PAT HEFTON REID CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S BRYANT AVE
EDMOND OK
73034-6309
US

IV. Provider business mailing address

PO BOX 19635
OKLAHOMA CITY OK
73144-0635
US

V. Phone/Fax

Practice location:
  • Phone: 405-692-2118
  • Fax: 405-605-5816
Mailing address:
  • Phone: 405-692-2118
  • Fax: 405-605-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR0019966
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: