MEDICARE: HEATHER DAVIS HIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	HADF1430	OK

General Provider Information

NPI Number	:	1174352215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER DAVIS HIS

Provider Business Mailing Address
First Line	:	10404 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6907
Country	:	US
Telephone Number	:	405-629-6235
Fax Number	:

Provider Business Practice Location Address
First Line	:	10404 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6907
Country	:	US
Telephone Number	:	405-629-6235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	07/29/2024

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Directions to “ HEATHER DAVIS HIS” Practice Location

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