Healthcare Provider Details

I. General information

NPI: 1497750343
Provider Name (Legal Business Name): HEATHER L HALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER LYLE

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 S YALE AVE LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
TULSA OK
74136-3326
US

IV. Provider business mailing address

PO BOX 21228 DEPARTMENT 31
TULSA OK
74121-1228
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-4000
  • Fax: 918-491-5740
Mailing address:
  • Phone: 918-481-4000
  • Fax: 918-491-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21340
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: