Provider Demographics
NPI:1467860585
Name:POWELL, KRISTIE MAE (APRN)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MAE
Last Name:POWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-5015
Mailing Address - Country:US
Mailing Address - Phone:918-779-0709
Mailing Address - Fax:918-758-1358
Practice Address - Street 1:109 W 6TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-5015
Practice Address - Country:US
Practice Address - Phone:918-779-0709
Practice Address - Fax:918-758-1358
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK73179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily