Provider Demographics
NPI:1336616713
Name:STRUS, CARLY (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:STRUS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 N COMMERCE ST STE 246
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1394
Mailing Address - Country:US
Mailing Address - Phone:580-226-3003
Mailing Address - Fax:580-798-3124
Practice Address - Street 1:2007 N COMMERCE ST STE 246
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1394
Practice Address - Country:US
Practice Address - Phone:580-226-3003
Practice Address - Fax:580-798-3124
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK112615363LW0102X
OK0112615163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory