Provider Demographics
NPI:1497368344
Name:ORR, CHARLON ANNETTE (APRN)
Entity Type:Individual
Prefix:
First Name:CHARLON
Middle Name:ANNETTE
Last Name:ORR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHARLON
Other - Middle Name:ANNETTE
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:888-247-0125
Mailing Address - Fax:918-502-8210
Practice Address - Street 1:2950 S ELM PL STE 120
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7816
Practice Address - Country:US
Practice Address - Phone:918-451-5191
Practice Address - Fax:918-246-5714
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2000941910AMedicaid