Provider Demographics
NPI:1699002253
Name:BRILLHART, HEIDY REBEKAH (APRN)
Entity type:Individual
Prefix:MRS
First Name:HEIDY
Middle Name:REBEKAH
Last Name:BRILLHART
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 6
Mailing Address - Street 2:
Mailing Address - City:KEYES
Mailing Address - State:OK
Mailing Address - Zip Code:73947-9609
Mailing Address - Country:US
Mailing Address - Phone:806-236-6840
Mailing Address - Fax:620-697-2185
Practice Address - Street 1:450 MORTON STREET
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950
Practice Address - Country:US
Practice Address - Phone:620-518-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0072633363LF0000X
KS53-76427-042363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201108100AMedicaid