Provider Demographics
NPI:1932403318
Name:SCHROEDER, DEBRA BEISTLE (ARNP)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:BEISTLE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2311
Mailing Address - Country:US
Mailing Address - Phone:918-518-5770
Mailing Address - Fax:918-518-5773
Practice Address - Street 1:1201 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2311
Practice Address - Country:US
Practice Address - Phone:918-518-5770
Practice Address - Fax:918-518-5773
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR35175363LF0000X
NA133N00000X
OK10928150163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
329716OtherPTAN
OK9712OtherMEDICAID PIN
OK200531260AMedicaid
285398YXJNMedicare PIN