Provider Demographics
NPI:1104092964
Name:HOOVER, CHARLENE D (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:D
Last Name:HOOVER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5232 N HIGHWAY 167
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-3434
Mailing Address - Country:US
Mailing Address - Phone:918-272-0033
Mailing Address - Fax:918-272-0039
Practice Address - Street 1:5232 N HIGHWAY 167
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3434
Practice Address - Country:US
Practice Address - Phone:918-272-0033
Practice Address - Fax:918-272-0039
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0074731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200416390BMedicaid