Provider Demographics
NPI:1164129201
Name:CIANCIO, KURSTYN JEAN
Entity Type:Individual
Prefix:
First Name:KURSTYN
Middle Name:JEAN
Last Name:CIANCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 AMY CT
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-9500
Mailing Address - Country:US
Mailing Address - Phone:580-216-2140
Mailing Address - Fax:
Practice Address - Street 1:2000 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6016
Practice Address - Country:US
Practice Address - Phone:405-248-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator