Provider Demographics
NPI:1306607676
Name:FUENTES, KRISTIANNA (LPN)
Entity type:Individual
Prefix:MRS
First Name:KRISTIANNA
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 E HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1156
Mailing Address - Country:US
Mailing Address - Phone:580-762-3217
Mailing Address - Fax:580-762-3224
Practice Address - Street 1:827 E HUBBARD RD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1156
Practice Address - Country:US
Practice Address - Phone:580-762-3217
Practice Address - Fax:580-762-3224
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201719164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse