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General NPI Number Information
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NPI Number | 1295401859
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Entity Type | Individual
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Provider Name | MARY ANN WARNER CARROLL PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 1919 S WHEELING AVE STE 200
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City | TULSA
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State | OK
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Zip | 74104-5631
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Country | US
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Telephone | 918-403-7089
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Fax |
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Provider Business Mailing Address
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Address Line | 701 W 101ST PL S APT 721
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City | JENKS
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State | OK
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Zip | 74037-3542
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Country | US
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Telephone | 918-600-8050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5167
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License Number State | OK
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