Healthcare Provider Details

I. General information

NPI: 1386694107
Provider Name (Legal Business Name): CARLEEN D CARLISLE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S UTICA AVE STE A
TULSA OK
74104-5346
US

IV. Provider business mailing address

1717 S UTICA AVE STE A
TULSA OK
74104-5346
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-7557
  • Fax: 918-403-0383
Mailing address:
  • Phone: 918-748-7557
  • Fax: 918-403-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0076525
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: