Healthcare Provider Details

I. General information

NPI: 1619961885
Provider Name (Legal Business Name): HEATHER K GEIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 GREENBRIAR PL #300
OKLAHOMA CITY OK
73159-7645
US

IV. Provider business mailing address

2816 NW 57TH ST 104
OKLAHOMA CITY OK
73112-7045
US

V. Phone/Fax

Practice location:
  • Phone: 405-692-4000
  • Fax: 405-692-4001
Mailing address:
  • Phone: 405-848-7882
  • Fax: 405-848-7818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number15710
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: