Healthcare Provider Details

I. General information

NPI: 1417200544
Provider Name (Legal Business Name): CORVETTA CARPENTER BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 HWY 33 LANGSTON COMMONS APT 15H
LANGSTON OK
73050-0400
US

IV. Provider business mailing address

PO BOX 412
LANGSTON OK
73050-0412
US

V. Phone/Fax

Practice location:
  • Phone: 405-612-6740
  • Fax:
Mailing address:
  • Phone: 405-612-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: