Provider Demographics
NPI:1528782323
Name:BAILEY, HEATHER LEONA
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEONA
Last Name:BAILEY
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 1:2630 N 11TH ST W
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-3920
Mailing Address - Country:US
Mailing Address - Phone:918-913-1284
Mailing Address - Fax:
Practice Address - Street 1:2630 N 11TH ST W
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-3920
Practice Address - Country:US
Practice Address - Phone:918-913-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator