Provider Demographics
NPI:1528600350
Name:MASSEY, CAITLIN AMANDA (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:AMANDA
Last Name:MASSEY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:AMANDA
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9900 N. 103RD EAST COURT
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055
Mailing Address - Country:US
Mailing Address - Phone:918-814-7777
Mailing Address - Fax:
Practice Address - Street 1:1923 S. UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-744-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK113882363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner