Healthcare Provider Details

I. General information

NPI: 1730988007
Provider Name (Legal Business Name): HEATHER DAWN GRENINGER APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14226 S ELM ST
GLENPOOL OK
74033-3525
US

IV. Provider business mailing address

14226 S ELM ST
GLENPOOL OK
74033-3525
US

V. Phone/Fax

Practice location:
  • Phone: 918-231-7474
  • Fax:
Mailing address:
  • Phone: 918-231-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number222266
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: