Provider Demographics
NPI:1932618469
Name:GREEN, CARLA DELYNN (APRN NP-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:DELYNN
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN NP-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3608 S FOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2477
Mailing Address - Country:US
Mailing Address - Phone:405-535-5155
Mailing Address - Fax:918-225-4559
Practice Address - Street 1:2340 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2905
Practice Address - Country:US
Practice Address - Phone:918-225-6904
Practice Address - Fax:918-225-4559
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKR0053789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily