MEDICARE: MS. ELIZABETH ANN CARLTON APRN

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	208000000X	Pediatrics Physician	76872	OK

General Provider Information

NPI Number	:	1720494354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ANN CARLTON APRN

Provider Business Mailing Address
First Line	:	PO BOX 890070
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73189-0070
Country	:	US
Telephone Number	:	405-378-2222
Fax Number	:	405-378-2240

Provider Business Practice Location Address
First Line	:	10400 S WESTERN AVE
Second Line	:	SUITE 7
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-3016
Country	:	US
Telephone Number	:	405-378-2222
Fax Number	:	405-378-2240

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

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	07/10/2014

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