Provider Demographics
NPI:1841076403
Name:O'CONNER, CAROLYN ONEIDA (FNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ONEIDA
Last Name:O'CONNER
Suffix:
Gender:F
Credentials:FNP
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 230
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921-0240
Mailing Address - Country:US
Mailing Address - Phone:662-647-5816
Mailing Address - Fax:
Practice Address - Street 1:171 DR TT LEWIS CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921-2400
Practice Address - Country:US
Practice Address - Phone:662-647-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily