Provider Demographics
NPI:1740644970
Name:CARTLIDGE, PENNI (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:PENNI
Middle Name:
Last Name:CARTLIDGE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:PENNI
Other - Middle Name:
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:201 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-7213
Mailing Address - Country:US
Mailing Address - Phone:580-453-3156
Mailing Address - Fax:580-453-3157
Practice Address - Street 1:905 COLONY DR
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2329
Practice Address - Country:US
Practice Address - Phone:580-436-5111
Practice Address - Fax:580-453-3157
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0069691390200000X
OK69691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program