Provider Demographics
NPI:1063851863
Name:CRAIG, JENNIFER CHRISTINA (CST)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CHRISTINA
Last Name:CRAIG
Suffix:
Gender:F
Credentials:CST
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:CHRISTINE
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:6465 S YALE AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7823
Mailing Address - Country:US
Mailing Address - Phone:918-481-4800
Mailing Address - Fax:918-481-4815
Practice Address - Street 1:6465 S YALE AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7823
Practice Address - Country:US
Practice Address - Phone:918-481-4800
Practice Address - Fax:918-481-4815
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK91275246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist