Individual
CHARLENE ELAINE REUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1084 NICKERSON ST, WAYNOKA, OK 73860
(580) 824-2291
(580) 824-0429
Mailing address
5300 N INDEPENDENCE AVE STE 280, OKLAHOMA CITY, OK 73112-5555
(580) 824-2291
(580) 824-0429
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1500390
KS
363A00000X
Physician Assistant
Primary
2549
OK
363AM0700X
Medical Physician Assistant
1500390
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100287510D
—
KS
05
—
100287510F
—
KS
01
—
426724
BLUE CROSS/BLUE SHIELD
KS
Enumeration date
06/16/2005
Last updated
10/17/2018
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