=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245167709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER ANN JUSTICE RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2026
-----------------------------------------------------
Last Update Date | 05/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6604 NW 124TH ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73142-3107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-863-2233
-----------------------------------------------------
Fax | 405-863-2233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6604 NW 124TH ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73142-3107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-863-2233
-----------------------------------------------------
Fax | 405-863-2233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | R0103383
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------