Provider Demographics
NPI:1699133520
Name:KRISTEN CLOUSE DNP, PMHNP-BC, LLC
Entity type:Organization
Organization Name:KRISTEN CLOUSE DNP, PMHNP-BC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CLOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN CNP
Authorized Official - Phone:580-208-2395
Mailing Address - Street 1:108 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-4848
Mailing Address - Country:US
Mailing Address - Phone:580-208-2395
Mailing Address - Fax:580-208-2396
Practice Address - Street 1:108 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-4848
Practice Address - Country:US
Practice Address - Phone:580-208-2395
Practice Address - Fax:580-208-2396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-06
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99530363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty