Healthcare Provider Details

I. General information

NPI: 1043642580
Provider Name (Legal Business Name): CARRIE B. MCCRACKEN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S. 101ST EAST AVENUE SUITE 200
TULSA OK
74133
US

IV. Provider business mailing address

8803 S. 101ST EAST AVENUE SUITE 200
TULSA OK
74133
US

V. Phone/Fax

Practice location:
  • Phone: 918-307-2273
  • Fax: 918-307-0273
Mailing address:
  • Phone: 918-307-2273
  • Fax: 918-307-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR0086846
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: