Provider Demographics
NPI:1700302304
Name:CARPENTER, JUDY ANN (FNP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:CARPENTER
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 1:1923 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-403-7066
Mailing Address - Fax:918-744-2946
Practice Address - Street 1:3400 E FRANK PHILLIPS BLVD STE 501
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2405
Practice Address - Country:US
Practice Address - Phone:918-331-2415
Practice Address - Fax:918-331-2551
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78421363LF0000X
OK217779363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200806790AMedicaid