Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R0086846 | OK |
NPI | 1043642580 |
---|---|
Provider Name | Ms. Carrie B. Mccracken |
First Address | Tulsa, OK 74133 |
Second Address | Tulsa, OK 74133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2013 |
Last Update Date | 07/08/2013 |