Provider Demographics
NPI:1033169933
Name:BAKER, KRISTY RENEA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:RENEA
Last Name:BAKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-323-1937
Mailing Address - Fax:580-323-1156
Practice Address - Street 1:211 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5437
Practice Address - Country:US
Practice Address - Phone:580-323-1937
Practice Address - Fax:580-323-1156
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0057523363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200083240AMedicaid
OK200083240BMedicaid
OKQ70137Medicare UPIN
OK200083240AMedicaid