Provider Demographics
NPI:1336839489
Name:WILLIAMS HEARD, CARLETTA MARIE NIGHTFOXRUSHIN
Entity type:Individual
Prefix:
First Name:CARLETTA
Middle Name:MARIE NIGHTFOXRUSHIN
Last Name:WILLIAMS HEARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 E INDEPENDENCE ST STE I
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-4037
Mailing Address - Country:US
Mailing Address - Phone:405-915-8051
Mailing Address - Fax:
Practice Address - Street 1:429 N UNION AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-7064
Practice Address - Country:US
Practice Address - Phone:405-275-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator