Provider Demographics
NPI:1659623627
Name:A STEP BEYOND THE REST: HEALTHCARE INNOVATIONS
Entity Type:Organization
Organization Name:A STEP BEYOND THE REST: HEALTHCARE INNOVATIONS
Other - Org Name:AMANDA RECKER APRN-CNP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RECKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:580-856-2102
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:1 MEDICAL PLAZA
Mailing Address - City:RATLIFF CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73481-0026
Mailing Address - Country:US
Mailing Address - Phone:580-856-2102
Mailing Address - Fax:580-856-3757
Practice Address - Street 1:1 MEDICAL PLAZA
Practice Address - Street 2:BOX 26
Practice Address - City:RATLIFF CITY
Practice Address - State:OK
Practice Address - Zip Code:73481-0026
Practice Address - Country:US
Practice Address - Phone:580-856-2102
Practice Address - Fax:580-856-3607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK85617261QP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1467753004OtherAUTHORIZED PROVIDER NPI