Healthcare Provider Details

I. General information

NPI: 1497827372
Provider Name (Legal Business Name): JEANNE E HEYSER EASTERLY DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date: 01/30/2008
Reactivation Date: 02/22/2010

III. Provider practice location address

800 S JACKSON AVE
TULSA OK
74127-9003
US

IV. Provider business mailing address

PO BOX 21228 DEPT 94
TULSA OK
74121-1228
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-4668
  • Fax: 918-749-4669
Mailing address:
  • Phone: 918-299-8232
  • Fax: 918-299-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2417
License Number StateOK

VIII. Authorized Official

Name: MRS. JEANNE ELIZABETH HEYSER EASTERLY
Title or Position: OWNER
Credential: DO
Phone: 918-749-4668