Provider Demographics
NPI:1891528550
Name:CHRISTIAN, GLORY KALPESH (NP)
Entity type:Individual
Prefix:
First Name:GLORY
Middle Name:KALPESH
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9562 S 96TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6158
Mailing Address - Country:US
Mailing Address - Phone:918-714-6972
Mailing Address - Fax:
Practice Address - Street 1:2410 N COLLEGE AVE STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3352
Practice Address - Country:US
Practice Address - Phone:479-485-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR230162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily