Healthcare Provider Details

I. General information

NPI: 1538482856
Provider Name (Legal Business Name): CATHY HEINEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MILE E. US HWY 270
FORT SUPPLY OK
73841
US

IV. Provider business mailing address

1222 10TH ST STE 211
WOODWARD OK
73801-3156
US

V. Phone/Fax

Practice location:
  • Phone: 580-766-2311
  • Fax: 580-766-2017
Mailing address:
  • Phone: 580-256-8615
  • Fax: 580-256-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number44505
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: