Provider Demographics
NPI:1861974008
Name:EVANS, HEATHER LEIGH (MS, RD/LD)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEIGH
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS, RD/LD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEIGH
Other - Last Name:HARGRAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1978 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1931
Mailing Address - Country:US
Mailing Address - Phone:918-924-6808
Mailing Address - Fax:
Practice Address - Street 1:1978 W 65TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1931
Practice Address - Country:US
Practice Address - Phone:918-924-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2278133V00000X
133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal