Healthcare Provider Details

I. General information

NPI: 1215755574
Provider Name (Legal Business Name): SAMANTHA NICOLE SCHEITZACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S ORCHARD ST
STILLWATER OK
74074-4218
US

IV. Provider business mailing address

1804 OAK FOREST DR
EDMOND OK
73025-2531
US

V. Phone/Fax

Practice location:
  • Phone: 405-780-6650
  • Fax: 405-844-0562
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5691
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: