Healthcare Provider Details

I. General information

NPI: 1417945346
Provider Name (Legal Business Name): HEATHER RENEE' RANGER KOBEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 S MINGO RD
TULSA OK
74133-5710
US

IV. Provider business mailing address

9320 S MINGO RD
TULSA OK
74133-5710
US

V. Phone/Fax

Practice location:
  • Phone: 918-901-9701
  • Fax: 918-901-9702
Mailing address:
  • Phone: 918-901-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: