MEDICARE: MARLENE JANETH BEATY APRN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	92390	OK

General Provider Information

NPI Number	:	1972025419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE JANETH BEATY APRN CNP

Provider Business Mailing Address
First Line	:	1325 PEMBROKE DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-2750
Country	:	US
Telephone Number	:	405-812-8244
Fax Number	:

Provider Business Practice Location Address
First Line	:	2716 SW 44TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-3339
Country	:	US
Telephone Number	:	405-778-0700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2017
Last Update Date	:	07/15/2017

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