Healthcare Provider Details

I. General information

NPI: 1124498282
Provider Name (Legal Business Name): ANGELA C. BAUSTERT DNP, APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 FAIRFAX DR STE 100
EDMOND OK
73034-3521
US

IV. Provider business mailing address

2901 FAIRFAX DR STE 100
EDMOND OK
73034-3521
US

V. Phone/Fax

Practice location:
  • Phone: 405-216-3437
  • Fax: 405-645-7885
Mailing address:
  • Phone: 405-216-3437
  • Fax: 405-645-7885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0091119
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: