Healthcare Provider Details

I. General information

NPI: 1861974008
Provider Name (Legal Business Name): HEATHER LEIGH EVANS MS, RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER LEIGH HARGRAVE

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1978 W 65TH ST
TULSA OK
74132-1931
US

IV. Provider business mailing address

1978 W 65TH ST
TULSA OK
74132-1931
US

V. Phone/Fax

Practice location:
  • Phone: 918-924-6808
  • Fax:
Mailing address:
  • Phone: 918-924-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2278
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: