Provider Demographics
NPI:1992746200
Name:OLIVO, KRISTY M (PA)
Entity type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:M
Last Name:OLIVO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:14024 QUAIL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1006
Mailing Address - Country:US
Mailing Address - Phone:405-424-5426
Mailing Address - Fax:405-424-5431
Practice Address - Street 1:9800 BROADWAY EXT
Practice Address - Street 2:SUITE 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6303
Practice Address - Country:US
Practice Address - Phone:405-424-5426
Practice Address - Fax:405-424-5431
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ22249Medicare UPIN
OHTOPA79131Medicare PIN