Provider Demographics
NPI:1992156913
Name:CRASE, CHARITY TYLER
Entity type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:TYLER
Last Name:CRASE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHARITY
Other - Middle Name:TYLER
Other - Last Name:BOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-1030
Mailing Address - Country:US
Mailing Address - Phone:580-298-2830
Mailing Address - Fax:580-298-6723
Practice Address - Street 1:401 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-3502
Practice Address - Country:US
Practice Address - Phone:918-649-0230
Practice Address - Fax:918-649-1492
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator