Individual
ANDREA CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
12697 E 51ST ST, TULSA, OK 74146-6236
(918) 505-3200
Mailing address
12697 E 51ST ST, TULSA, OK 74146-6236
(918) 343-8560
(918) 505-3200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
104922
OK
363L00000X
Nurse Practitioner
Primary
104922
OK
363L00000X
Nurse Practitioner
R0104922
OK
363LF0000X
Family Nurse Practitioner
R0104922
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200915270A
—
OK
Enumeration date
08/04/2019
Last updated
02/07/2023
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