Provider Demographics
NPI:1073594032
Name:LAFFOON, CARL LEE (ARNP)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:LEE
Last Name:LAFFOON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 E HWY 37
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-8581
Mailing Address - Country:US
Mailing Address - Phone:405-381-5111
Mailing Address - Fax:405-381-5138
Practice Address - Street 1:5100 E HWY 37
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-8581
Practice Address - Country:US
Practice Address - Phone:405-381-5111
Practice Address - Fax:405-381-5138
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR54748363L00000X
OKR0054748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200002980DMedicaid
ML0899546OtherDEA
OKP80417Medicare UPIN