Provider Demographics
NPI:1386373108
Name:HARNER, KRISTINA
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:HARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:WAPANUCKA
Mailing Address - State:OK
Mailing Address - Zip Code:73461-0383
Mailing Address - Country:US
Mailing Address - Phone:580-371-5557
Mailing Address - Fax:
Practice Address - Street 1:2701 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2997
Practice Address - Country:US
Practice Address - Phone:580-740-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator