Provider Demographics
NPI:1679668552
Name:CARLSON, KATHLEEN LOREE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LOREE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7614 E 91ST STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6047
Mailing Address - Country:US
Mailing Address - Phone:918-495-1144
Mailing Address - Fax:918-495-3518
Practice Address - Street 1:7614 E 91ST STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6047
Practice Address - Country:US
Practice Address - Phone:918-495-1144
Practice Address - Fax:918-495-3518
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK11624207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK11624OtherOK STATE BOARD
OK14980OtherSTATE BUREAU OF NARCOTICS
AC8351873OtherDEPT OF JUSTICE
OK14980OtherSTATE BUREAU OF NARCOTICS