Provider Demographics
NPI:1679030761
Name:CARTER, KATEY (DPH, MBA)
Entity Type:Individual
Prefix:DR
First Name:KATEY
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:DPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 S MAY AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2501
Mailing Address - Country:US
Mailing Address - Phone:405-378-7171
Mailing Address - Fax:405-378-7176
Practice Address - Street 1:10601 S MAY AVE STE 11
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-2501
Practice Address - Country:US
Practice Address - Phone:405-378-7171
Practice Address - Fax:405-378-7176
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200293490AMedicaid