Provider Demographics
NPI:1073201414
Name:WHITAKER, CAROLINE ANNE (PMHNP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANNE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 QUAIL CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2442
Mailing Address - Country:US
Mailing Address - Phone:918-916-9924
Mailing Address - Fax:
Practice Address - Street 1:1105 SW 30TH CT
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2887
Practice Address - Country:US
Practice Address - Phone:405-378-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK212466363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health