Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 81105 | OK |
NPI | 1134515034 |
---|---|
Provider Name | Carrie Judkins |
First Address | Oklahoma City, OK 73104-5047 |
Second Address | Oklahoma City, OK 73104-5047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 08/04/2015 |