Provider Demographics
NPI:1285626945
Name:ALLGOOD, BETH A (CRNA)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:ALLGOOD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6418
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73506-0418
Mailing Address - Country:US
Mailing Address - Phone:580-536-2010
Mailing Address - Fax:580-536-5773
Practice Address - Street 1:1003 NW BECONTREE PL
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4126
Practice Address - Country:US
Practice Address - Phone:580-536-2010
Practice Address - Fax:580-536-5773
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0042455367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R11027Medicare UPIN