Healthcare Provider Details

I. General information

NPI: 1083411961
Provider Name (Legal Business Name): HEATHER ANTHONY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13301 N MERIDIAN AVE STE 100
OKLAHOMA CITY OK
73120-8357
US

IV. Provider business mailing address

1008 24TH AVE NW
NORMAN OK
73069-6369
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-3262
  • Fax:
Mailing address:
  • Phone: 405-310-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21426-P
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: