Provider Demographics
NPI:1295401859
Name:CARROLL, MARY ANN WARNER (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN WARNER
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 W 101ST PL S APT 721
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3542
Mailing Address - Country:US
Mailing Address - Phone:918-600-8050
Mailing Address - Fax:
Practice Address - Street 1:1919 S WHEELING AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5631
Practice Address - Country:US
Practice Address - Phone:918-403-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK5167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant