Healthcare Provider Details

I. General information

NPI: 1417598574
Provider Name (Legal Business Name): BARBRA LYNN CALDWELL APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26945 E 143RD ST S
COWETA OK
74429-6685
US

IV. Provider business mailing address

315 S UTICA AVE
TULSA OK
74104-2203
US

V. Phone/Fax

Practice location:
  • Phone: 918-694-1026
  • Fax:
Mailing address:
  • Phone: 918-694-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number86488
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number86488
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: