Healthcare Provider Details

I. General information

NPI: 1699630285
Provider Name (Legal Business Name): AMANDA WOOLMAN- CARNES PHD FUNCTIONAL MED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 S LEWIS AVE
TULSA OK
74104-5343
US

IV. Provider business mailing address

1733 S LEWIS AVE
TULSA OK
74104-5343
US

V. Phone/Fax

Practice location:
  • Phone: 970-470-0731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberNPCN-17616-15816
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: