Healthcare Provider Details

I. General information

NPI: 1457214819
Provider Name (Legal Business Name): REBECCA PFINGSTEN BS, MAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S ARENA RD
MCLOUD OK
74851-7906
US

IV. Provider business mailing address

1900 S ARENA RD
MCLOUD OK
74851-7906
US

V. Phone/Fax

Practice location:
  • Phone: 572-219-0769
  • Fax:
Mailing address:
  • Phone: 719-963-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: