Provider Demographics
NPI:1104455765
Name:MERCER, HEATHER NICOLE (DO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:MERCER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1334 N LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-5907
Mailing Address - Country:US
Mailing Address - Phone:918-587-2171
Mailing Address - Fax:918-587-4534
Practice Address - Street 1:14002 E. 21ST ST.
Practice Address - Street 2:SUITE 1130
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134
Practice Address - Country:US
Practice Address - Phone:918-439-1500
Practice Address - Fax:918-439-1199
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine