Healthcare Provider Details

I. General information

NPI: 1407227135
Provider Name (Legal Business Name): DENISE BEARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 NW 157TH ST
EDMOND OK
73013-1404
US

IV. Provider business mailing address

1828 NW 157TH ST
EDMOND OK
73013-1404
US

V. Phone/Fax

Practice location:
  • Phone: 405-974-8374
  • Fax:
Mailing address:
  • Phone: 405-974-8374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number77722
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: