Healthcare Provider Details

I. General information

NPI: 1124374129
Provider Name (Legal Business Name): CAMBER DEAN CLINE APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 DOUGLAS AVE
BEAVER OK
73932-9650
US

IV. Provider business mailing address

23 AVENUE L
BEAVER OK
73932-3486
US

V. Phone/Fax

Practice location:
  • Phone: 580-625-0042
  • Fax: 405-281-4917
Mailing address:
  • Phone: 405-612-7358
  • Fax: 405-281-4917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number88840
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: