Main Street Family Clinic Aprn-CNP PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

R00035175 Issued in OK

Legal business name

MAIN STREET FAMILY CLINIC APRN-CNP PLLC

Practice address

1201 W Main St
Jenks, OK 74037-2311

Phone

(918) 518-5770

Fax

(918) 518-5773

NPI assigned

Aug 22, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Debra Beistle Schroeder, APRN-CNPNPI 1932403318

Title

Family Nurse Practitioner

Phone

(918) 518-5770

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Debra Beistle Schroeder, ARNP

  • Family Nurse Practitioner
  • Jenks, OK
  • NPI 1932403318
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1811321102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 W MAIN ST",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740372311",
            "telephone_number": "918-518-5770",
            "fax_number": "918-518-5773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W MAIN ST",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740372311",
            "telephone_number": "918-518-5770",
            "fax_number": "918-518-5773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET FAMILY CLINIC APRN-CNP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-22",
        "last_updated": "2013-12-11",
        "status": "A",
        "authorized_official_last_name": "SCHROEDER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "BEISTLE",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "918-518-5770",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN-CNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OK",
            "license": "R00035175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Jenks, OK
• Providers in Jenks, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.