Provider Demographics
NPI:1184855389
Name:COUSSENS, CAROLINE POWELL (RN,ACNS-BC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:POWELL
Last Name:COUSSENS
Suffix:
Gender:F
Credentials:RN,ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 W 46TH ST N
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74126-6675
Mailing Address - Country:US
Mailing Address - Phone:918-430-9984
Mailing Address - Fax:918-430-1013
Practice Address - Street 1:200 W 46TH ST N
Practice Address - Street 2:DREAM CENTER
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74126-6675
Practice Address - Country:US
Practice Address - Phone:918-430-9984
Practice Address - Fax:918-430-1013
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0042972364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health