Provider Demographics
NPI:1710909700
Name:COACHMAN, CHARLOTTE L (ARNP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:L
Last Name:COACHMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 E THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4733
Mailing Address - Country:US
Mailing Address - Phone:918-576-9862
Mailing Address - Fax:
Practice Address - Street 1:4785 E 91ST ST STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2839
Practice Address - Country:US
Practice Address - Phone:918-556-7845
Practice Address - Fax:918-556-7849
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0027590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner