MEDICARE: CARRIE KAYE EVANS APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	205577	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205577	OTHER	OK	BON APRN-CNP LICENSE
2	F08210942	OTHER		AAPNCB

General Provider Information

NPI Number	:	1124795349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE KAYE EVANS APRN-CNP

Provider Business Mailing Address
First Line	:	908 N ROCKFORD RD STE A
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-2541
Country	:	US
Telephone Number	:	580-223-0447
Fax Number	:	580-223-2989

Provider Business Practice Location Address
First Line	:	908 N ROCKFORD RD STE A
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-2541
Country	:	US
Telephone Number	:	580-223-0447
Fax Number	:	580-223-2989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	02/08/2023

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