Healthcare Provider Details

I. General information

NPI: 1831742741
Provider Name (Legal Business Name): TRACY M BAUSTERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 03/24/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E HWY 66 EL RENO
OKLAHOMA OK
73036
US

IV. Provider business mailing address

17250 N SHEPARD AVE
OKARCHE OK
73762-2058
US

V. Phone/Fax

Practice location:
  • Phone: 405-226-1798
  • Fax:
Mailing address:
  • Phone: 405-226-1798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: