Provider Demographics
NPI:1326407396
Name:CHANCE, CHARLOTTE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:CHANCE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 E VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4245
Practice Address - Country:US
Practice Address - Phone:918-421-8440
Practice Address - Fax:918-421-8450
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK127909363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1326407396OtherNPI
CO34750088Medicaid
P01631540OtherRAILROAD WORKERS MEDICARE FOR MOUNTAIN PEAKS URGENT CARE