Provider Demographics
NPI:1902876360
Name:POHL, CARLA JEAN (CNM)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEAN
Last Name:POHL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:JEAN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-660-3632
Mailing Address - Fax:918-660-3631
Practice Address - Street 1:2815 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129
Practice Address - Country:US
Practice Address - Phone:918-619-4200
Practice Address - Fax:918-619-4216
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0070127367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200054730AMedicaid
OK200054730AMedicaid
Q51932Medicare UPIN