1992156913 NPI number — MRS. CHARITY TYLER CRASE

Table of content: MRS. CHARITY TYLER CRASE (NPI 1992156913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992156913 NPI number — MRS. CHARITY TYLER CRASE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRASE
Provider First Name:
CHARITY
Provider Middle Name:
TYLER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOWER
Provider Other First Name:
CHARITY
Provider Other Middle Name:
TYLER
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992156913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1030
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANTLERS
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74523-1030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-298-2830
Provider Business Mailing Address Fax Number:
580-298-6723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 N CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTEAU
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74953-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-649-0230
Provider Business Practice Location Address Fax Number:
918-649-1492
Provider Enumeration Date:
06/30/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)