Healthcare Provider Details

I. General information

NPI: 1558756718
Provider Name (Legal Business Name): HEATHER MCLEMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPWY
OKLAHOMA CITY OK
73112-4418
US

IV. Provider business mailing address

307 S EVERGREEN AVE
WOODBURY NJ
08096-2739
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-3011
  • Fax:
Mailing address:
  • Phone: 856-686-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number43483
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-11016
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: