Provider Demographics
NPI:1962129726
Name:RACHEL CRIST LLC
Entity type:Organization
Organization Name:RACHEL CRIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL FIRST ASSIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:CRIST
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:918-944-8333
Mailing Address - Street 1:2612 W LAREDO ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7475
Mailing Address - Country:US
Mailing Address - Phone:918-944-8333
Mailing Address - Fax:
Practice Address - Street 1:2612 W LAREDO ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7475
Practice Address - Country:US
Practice Address - Phone:918-944-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty