Healthcare Provider Details

I. General information

NPI: 1598213134
Provider Name (Legal Business Name): TARA L. SCHULTZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 SW 44TH ST STE A
OKLAHOMA CITY OK
73179-4309
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE STE 280
OKLAHOMA CITY OK
73112-5555
US

V. Phone/Fax

Practice location:
  • Phone: 405-357-3500
  • Fax: 405-357-3519
Mailing address:
  • Phone: 405-357-3500
  • Fax: 405-357-3519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number74108
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: