TRISTA BEAVERS (NPI# 1871924423) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871924423 |
| Entity Type | Individual |
| Full Name | TRISTA BEAVERS |
| Credential | BHCM I |
| Practice Address |
109 N Fairland St Pryor OK 74361-4203 |
| Practice Telephone | 9188251405 |
| Practice Fax Number | 9188251406 |
| Mailing Telephone | 9188251405 |
| Mailing Fax Number | 9188251406 |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2018-02-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
109 N FAIRLAND ST |
| City | PRYOR |
| State | OK |
| Zip Code | 74361-4203 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942286133 | Jan Ellen Wells | Nurse Practitioner | 109 N Fairland St, Suite 104, Pryor, OK 74361-4203 | 2005-12-19 |
| 1740893296 | Erin Dinsmore | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4205 | 2020-08-25 |
| 1609489228 | Wendy Dotson | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-08-24 |
| 1063022077 | Daylon Cheyenne Ramsey | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4205 | 2020-08-04 |
| 1548885502 | Riley Danielle Pope | Counselor | 109 N Fairland St, Pryor, OK 74361-4205 | 2020-06-15 |
| 1013532076 | Breanna Nicole Cook | Counselor | 109 N Fairland St, Pryor, OK 74361-4205 | 2020-06-15 |
| 1285254490 | Briana Renee Andrews | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-04-17 |
| 1215556410 | Carly Ann Disalvatore | Case Manager/Care Coordinator | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-04-09 |
| 1568081677 | Zack Ellard | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-04-09 |
| 1518593011 | Klarissa Autumn Hall | Occupational Therapy Assistant | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-03-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740787928 | Ahs Pryor Hospital, LLC | Clinic/Center | 1301 Ne 1st St Ste 400, Pryor, OK 74361 | 2018-04-12 |
| 1073029310 | Amber Bowman | Registered Nurse | 109 N. Fairland, Pryor, OK 74361 | 2017-12-22 |
| 1922361096 | Crystal Noel Parrett | Counselor | 215 N. Fairland, Pryor, OK 74361 | 2012-06-22 |
| 1447516703 | Rocky Mountain Holdings LLC | Ambulance | 591 Airport Rd, Pryor, OK 74361 | 2012-04-11 |
| 1356673180 | Tressa Fern Rice | Speech-Language Pathologist | 510 S. Elliott St. Suite C, Mayes County Speech Therapy, Pryor, OK 74361 | 2010-02-04 |
| 1083945208 | Ladena Carol Moore | Counselor | 212 S E 1st, Pryor, OK 74361 | 2010-01-28 |
| 1164753323 | Anita K Sanders | Counselor | 212 Se 1st, Pryor, OK 74361 | 2010-01-27 |
| 1619203775 | Sandra Kay Runnells | Psychologist | 109 South Fairland, Suite 101, Pryor, OK 74361 | 2009-10-26 |
| 1972838969 | Ramona L Whitehurst | Advanced Practice Midwife | 1400 Willow Road, Pryor, OK 74361 | 2009-10-08 |
| 1396971297 | Shauna Leann Jackson | Speech-Language Pathologist | 510 S. Elliott, Suite C, Pryor, OK 74361 | 2009-06-05 |
| Find all providers in zip 74361 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518566264 | Vincent Oaks Cox | Peer Specialist | 3585 S 439, Pryor, OK 74361-9346 | 2020-10-23 |
| 1831715622 | Katrina Ann Deutscher | Peer Specialist | 109 N Fairland St., Pryor, OK 74361-4203 | 2020-06-18 |
| 1740763630 | Alexander Corral | Peer Specialist | 209 Sw 2nd St, Pryor, OK 74361-3407 | 2018-09-07 |
| 1740893296 | Erin Dinsmore | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4205 | 2020-08-25 |
| 1609489228 | Wendy Dotson | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-08-24 |
| 1063022077 | Daylon Cheyenne Ramsey | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4205 | 2020-08-04 |
| 1285254490 | Briana Renee Andrews | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-04-17 |
| 1568081677 | Zack Ellard | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-04-09 |
| 1164057766 | Jamie Parker | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-03-04 |
| 1588295984 | Della Lea Littlefield | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-02-04 |
| Find all providers in PRYOR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.