Healthcare Provider Details

I. General information

NPI: 1124683578
Provider Name (Legal Business Name): CHELSEY MORGAN BEATHARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEY MORGAN BEATHARD DO

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BLISS AVE
TAHLEQUAH OK
74464-2512
US

IV. Provider business mailing address

100 S BLISS AVE
TAHLEQUAH OK
74464-2512
US

V. Phone/Fax

Practice location:
  • Phone: 918-458-3100
  • Fax:
Mailing address:
  • Phone: 918-458-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number6943
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: