Provider Demographics
NPI:1558620922
Name:CARTER, REBECCA KATHLEEN (APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KATHLEEN
Last Name:CARTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 SE 4TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7329
Mailing Address - Country:US
Mailing Address - Phone:405-799-7400
Mailing Address - Fax:405-799-7405
Practice Address - Street 1:1400 SE 4TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-7329
Practice Address - Country:US
Practice Address - Phone:405-799-7400
Practice Address - Fax:405-799-7405
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2020-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK76688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK76688OtherSTATE LICENSE