Healthcare Provider Details

I. General information

NPI: 1730992835
Provider Name (Legal Business Name): TERESA SCHULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LEE AVE
OKLAHOMA CITY OK
73102-1036
US

IV. Provider business mailing address

9908 SW 14TH ST
YUKON OK
73099-7670
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-6155
  • Fax:
Mailing address:
  • Phone: 405-863-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0135202
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221732
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4054279
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: