Healthcare Provider Details

I. General information

NPI: 1568602779
Provider Name (Legal Business Name): ANDREW KYLE CARTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 03/23/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4870 S LEWIS AVE STE 240
TULSA OK
74105-5153
US

IV. Provider business mailing address

4870 S LEWIS AVE STE 240
TULSA OK
74105-5153
US

V. Phone/Fax

Practice location:
  • Phone: 918-982-6524
  • Fax: 539-399-7559
Mailing address:
  • Phone: 918-982-6524
  • Fax: 539-399-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1823
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: