Individual
HEATHER C KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
7900 NW 23RD ST, SUITE 1, BETHANY, OK 73008-4961
(405) 470-3232
(405) 470-3233
Mailing address
7900 NW 23RD ST, SUITE 1, BETHANY, OK 73008-4961
(405) 470-3232
(405) 470-3233
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2191
OK
363AM0700X
Medical Physician Assistant
2191
PA
363AS0400X
Surgical Physician Assistant
2191
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200506010A
—
OK
Enumeration date
12/12/2012
Last updated
04/26/2016
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