Healthcare Provider Details

I. General information

NPI: 1659623627
Provider Name (Legal Business Name): A STEP BEYOND THE REST: HEALTHCARE INNOVATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA BOX 26
RATLIFF CITY OK
73481-0026
US

IV. Provider business mailing address

PO BOX 26 1 MEDICAL PLAZA
RATLIFF CITY OK
73481-0026
US

V. Phone/Fax

Practice location:
  • Phone: 580-856-2102
  • Fax: 580-856-3607
Mailing address:
  • Phone: 580-856-2102
  • Fax: 580-856-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number85617
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number85617
License Number StateOK

VIII. Authorized Official

Name: AMANDA RECKER
Title or Position: SOLE PROPRIETOR/OWNER
Credential: APRN-CNP
Phone: 580-856-2102