Provider Demographics
NPI:1649975988
Name:CARLILE, HEATHER LEIGH (RNC-OB, FNTP, BCHN,)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEIGH
Last Name:CARLILE
Suffix:
Gender:F
Credentials:RNC-OB, FNTP, BCHN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 N 4240 RD
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-6921
Mailing Address - Country:US
Mailing Address - Phone:580-317-5552
Mailing Address - Fax:
Practice Address - Street 1:389 N 4240 RD
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-9566
Practice Address - Country:US
Practice Address - Phone:580-317-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0064918133NN1002X, 163WD0400X, 163WM0102X, 163WX0003X, 171400000X, 363LW0102X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No171400000XOther Service ProvidersHealth & Wellness Coach
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health