Provider Demographics
NPI:1306886106
Name:EARLEY, KRISTIN F (DO)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:F
Last Name:EARLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:D
Other - Last Name:FRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6801 W MEMORIAL RD UNIT E
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2103
Mailing Address - Country:US
Mailing Address - Phone:405-491-4090
Mailing Address - Fax:405-491-4091
Practice Address - Street 1:5201 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2004
Practice Address - Country:US
Practice Address - Phone:405-755-4050
Practice Address - Fax:405-749-9566
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39874207Q00000X
OK4068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC398741Medicaid
SC398741Medicaid
900522214Medicare ID - Type UnspecifiedGROUP NUMBER