Provider Demographics
NPI:1063252153
Name:SPRINGFIELD, KRYSTAL BROOKE (RN)
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:BROOKE
Last Name:SPRINGFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4657
Mailing Address - Country:US
Mailing Address - Phone:580-421-1228
Mailing Address - Fax:
Practice Address - Street 1:430 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4657
Practice Address - Country:US
Practice Address - Phone:580-421-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0129790163WD0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty