Provider Demographics
NPI:1285926642
Name:KISTLER, WHITNEY NICOLE
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:NICOLE
Last Name:KISTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N DENVER AVE
Mailing Address - Street 2:STE. C
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-1806
Mailing Address - Country:US
Mailing Address - Phone:918-582-1200
Mailing Address - Fax:918-581-0777
Practice Address - Street 1:102 N DENVER AVE
Practice Address - Street 2:STE. C
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-1806
Practice Address - Country:US
Practice Address - Phone:918-582-1200
Practice Address - Fax:918-581-0777
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKTCBHMedicaid