Provider Demographics
NPI:1386826113
Name:DEMOND, CAROL ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:DEMOND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 S HIGHWAY 69A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-1016
Mailing Address - Country:US
Mailing Address - Phone:918-542-1655
Mailing Address - Fax:918-332-4395
Practice Address - Street 1:7600 S HIGHWAY 69A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1016
Practice Address - Country:US
Practice Address - Phone:918-542-1655
Practice Address - Fax:918-332-4395
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK69259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200468380CMedicaid
OK200186820AMedicaid
OK100710600GMedicaid
OK200186820AMedicaid
OK100710600GMedicaid