Provider Demographics
NPI:1013391689
Name:CARRIER, JODEE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JODEE
Middle Name:
Last Name:CARRIER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 N FOREMAN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-1435
Mailing Address - Country:US
Mailing Address - Phone:918-256-2261
Mailing Address - Fax:918-256-2304
Practice Address - Street 1:803 N FOREMAN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-1435
Practice Address - Country:US
Practice Address - Phone:918-964-9361
Practice Address - Fax:918-256-2304
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200596820AMedicaid
OK435782ZQYFMedicare PIN