Provider Demographics
NPI:1891792172
Name:MARTIN, SUSAN KAY (APN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960454
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0454
Mailing Address - Country:US
Mailing Address - Phone:800-684-0052
Mailing Address - Fax:405-844-1794
Practice Address - Street 1:5201 NORTHSHORE DR
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-5312
Practice Address - Country:US
Practice Address - Phone:501-748-8000
Practice Address - Fax:501-748-8000
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157708758Medicaid
P00218372OtherRAILROAD MEDICARE
ARP01121769OtherRAILROAD MEDICARE
AR246160YH95Medicare PIN
ARS64112Medicare UPIN
AR5U107Medicare PIN