Provider Demographics
NPI:1316609001
Name:HEIGLE, MARIS (PA-C)
Entity type:Individual
Prefix:
First Name:MARIS
Middle Name:
Last Name:HEIGLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20905
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-0905
Mailing Address - Country:US
Mailing Address - Phone:405-833-1108
Mailing Address - Fax:405-673-7325
Practice Address - Street 1:1932 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-1202
Practice Address - Country:US
Practice Address - Phone:405-833-1108
Practice Address - Fax:405-673-7325
Is Sole Proprietor?:No
Enumeration Date:2021-10-10
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363A00000X363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant