Provider Demographics
NPI:1801410576
Name:CARLILE, CHRISTIN CHEYENNE
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIN
Middle Name:CHEYENNE
Last Name:CARLILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 E 2010 RD
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-1057
Mailing Address - Country:US
Mailing Address - Phone:805-588-9776
Mailing Address - Fax:
Practice Address - Street 1:1212 E KIRK ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-3607
Practice Address - Country:US
Practice Address - Phone:580-743-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator