Provider Demographics
NPI:1689140220
Name:BROWN, KARLY LYNN (RT (R)(M) (ARRT))
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:RT (R)(M) (ARRT)
Other - Prefix:
Other - First Name:KARLY
Other - Middle Name:LYNN
Other - Last Name:FENSCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT (R)(M) (ARRT)
Mailing Address - Street 1:550 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-3820
Mailing Address - Country:US
Mailing Address - Phone:918-588-1900
Mailing Address - Fax:918-382-1285
Practice Address - Street 1:550 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3820
Practice Address - Country:US
Practice Address - Phone:918-588-1900
Practice Address - Fax:918-382-1285
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4539052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology