Provider Demographics
NPI:1497045165
Name:REAGAN MATHERLY, BETH (ARNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:REAGAN MATHERLY
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 1:5300 S TRIPLE X RD
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-5419
Mailing Address - Country:US
Mailing Address - Phone:405-391-6951
Mailing Address - Fax:
Practice Address - Street 1:304 N MERIDIAN AVE STE D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6535
Practice Address - Country:US
Practice Address - Phone:405-943-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR81261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily