Provider Demographics
NPI:1093497885
Name:DEGRAFFENREID, CRISTEN
Entity type:Individual
Prefix:
First Name:CRISTEN
Middle Name:
Last Name:DEGRAFFENREID
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SONOMA PARK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2092
Mailing Address - Country:US
Mailing Address - Phone:405-285-2260
Mailing Address - Fax:405-285-2280
Practice Address - Street 1:2000 SONOMA PARK DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2092
Practice Address - Country:US
Practice Address - Phone:405-285-2260
Practice Address - Fax:405-285-2280
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0067806363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily