Provider Demographics
NPI:1871105452
Name:CARPENTER, KATELYN CHEYANNE
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:CHEYANNE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437-4240
Mailing Address - Country:US
Mailing Address - Phone:918-650-9292
Mailing Address - Fax:
Practice Address - Street 1:316 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-4240
Practice Address - Country:US
Practice Address - Phone:918-650-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist