Healthcare Provider Details

I. General information

NPI: 1528562071
Provider Name (Legal Business Name): HEIDI N COOK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI N CHAMBERLAIN APN

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6585 S YALE AVE STE 720
TULSA OK
74136-8320
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-5930
  • Fax: 918-502-5935
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number200880
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: