Provider Demographics
NPI:1750917019
Name:WORTHAM, KARLEE JO (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KARLEE
Middle Name:JO
Last Name:WORTHAM
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39098 E 153RD ST S
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-8543
Mailing Address - Country:US
Mailing Address - Phone:918-706-0298
Mailing Address - Fax:
Practice Address - Street 1:39098 E 153RD ST S
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-8543
Practice Address - Country:US
Practice Address - Phone:918-706-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK121733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily