Provider Demographics
NPI:1083685135
Name:CARR, CANDACE M (CNS)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:M
Last Name:CARR
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9228 S MINGO RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5718
Mailing Address - Country:US
Mailing Address - Phone:918-592-0999
Mailing Address - Fax:918-878-2499
Practice Address - Street 1:1265 S UTICA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4243
Practice Address - Country:US
Practice Address - Phone:918-592-0999
Practice Address - Fax:918-592-1021
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0051791364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00117501OtherMEDICARE RAILROAD
OK100850620AMedicaid
OKOK400768OtherMEDICARE PTAN
OKP00611404OtherMEDICARE RAILROAD
OKP70842Medicare UPIN
OKP00611404OtherMEDICARE RAILROAD