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NPI Code Detail

MEDICARE: CHARLSIE RECORD

MEDICARE: CHARLSIE RECORD
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
1207R00000XInternal Medicine Physician104700OK
2363LF0000XFamily Nurse PractitionerR0104700OK

General Provider Information

NPI Number : 1972028249
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLSIE RECORD
Provider Business Mailing Address
First Line : 9101 WOODROW CT
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73169-3702
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10413 GREENBRIAR PKWY
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-7656
Country : US
Telephone Number : 405-691-4665
Fax Number : 405-378-7628
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2017
Last Update Date : 02/24/2026

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Directions to “ CHARLSIE RECORD ” Practice Location

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