=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871473926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETA AND BLOOM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2025
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13901 S WESTERN AVE STE 200
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73170-7052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-326-4152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13901 S WESTERN AVE STE 200
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73170-7052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-309-3222
-----------------------------------------------------
Fax | 405-652-0884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE OWNER
-----------------------------------------------------
Name | CHELSIE PETRIE
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 405-326-4152
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------