Healthcare Provider Details

I. General information

NPI: 1720308570
Provider Name (Legal Business Name): DEBRA NHUNG HEFNER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

IV. Provider business mailing address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

V. Phone/Fax

Practice location:
  • Phone: 918-567-7140
  • Fax: 918-567-7113
Mailing address:
  • Phone: 918-567-7140
  • Fax: 918-567-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOK-5385
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number5385
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: