MEDICARE: CARRIE CULVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	79647	OK

General Provider Information

NPI Number	:	1942747837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE CULVER

Provider Business Mailing Address
First Line	:	1715 N 5TH ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-2763
Country	:	US
Telephone Number	:	580-762-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 N 5TH ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-2763
Country	:	US
Telephone Number	:	580-762-9292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	09/16/2020

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Directions to “ CARRIE CULVER ” Practice Location

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