Individual
MS. DEBRA BEISTLE SCHROEDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1201 W MAIN ST, JENKS, OK 74037-2311
(918) 518-5770
(918) 518-5773
Mailing address
1201 W MAIN ST, JENKS, OK 74037-2311
(918) 518-5770
(918) 518-5773
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
NA
—
163WL0100X
Lactation Consultant (Registered Nurse)
10928150
OK
363LF0000X
Family Nurse Practitioner
Primary
R35175
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200531260A
—
OK
01
—
329716
PTAN
—
01
—
9712
MEDICAID PIN
OK
Enumeration date
12/29/2010
Last updated
06/04/2014
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