Healthcare Provider Details

I. General information

NPI: 1871377952
Provider Name (Legal Business Name): CAROLINE CARSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NW 9TH ST STE 100
OKLAHOMA CITY OK
73106-7248
US

IV. Provider business mailing address

800 NW 9TH ST STE 100
OKLAHOMA CITY OK
73106-7248
US

V. Phone/Fax

Practice location:
  • Phone: 405-815-5050
  • Fax:
Mailing address:
  • Phone: 918-892-8478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5713
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: