Healthcare Provider Details

I. General information

NPI: 1568130920
Provider Name (Legal Business Name): CARRIE WOLHART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MAIN ST
HENRYETTA OK
74437-4241
US

IV. Provider business mailing address

401 W MAIN ST
HENRYETTA OK
74437-4241
US

V. Phone/Fax

Practice location:
  • Phone: 918-650-3085
  • Fax:
Mailing address:
  • Phone: 539-667-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number206098
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: