Provider Demographics
NPI:1447622733
Name:CARPENTER, CHRISTIE R (APRN-FNP-CNP)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:R
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:APRN-FNP-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 W LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-1703
Mailing Address - Country:US
Mailing Address - Phone:580-889-3355
Mailing Address - Fax:580-889-5272
Practice Address - Street 1:109 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WETUMKA
Practice Address - State:OK
Practice Address - Zip Code:74883
Practice Address - Country:US
Practice Address - Phone:405-452-5400
Practice Address - Fax:405-452-3000
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKROO66926363L00000X, 363L00000X
NY345416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0066926Medicaid