Provider Demographics
NPI:1538818000
Name:WISOTSKY, HALEIGH BROOKE (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:HALEIGH
Middle Name:BROOKE
Last Name:WISOTSKY
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:MISS
Other - First Name:HALEIGH
Other - Middle Name:BROOKE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:738 W 97TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3406
Mailing Address - Country:US
Mailing Address - Phone:918-809-3514
Mailing Address - Fax:
Practice Address - Street 1:9716 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7447
Practice Address - Country:US
Practice Address - Phone:918-528-4897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily