Provider Demographics
NPI:1164792040
Name:WHITAKER, KRISTI LYN (BS,BHRS,CMII)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:LYN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:BS,BHRS,CMII
Other - Prefix:MISS
Other - First Name:KRISTI
Other - Middle Name:LYN
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS,BHRS,CMII
Mailing Address - Street 1:4444 E 41ST ST.
Mailing Address - Street 2:SUITE 1120
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135
Mailing Address - Country:US
Mailing Address - Phone:918-660-3150
Mailing Address - Fax:918-660-3143
Practice Address - Street 1:4444 E 41ST ST.
Practice Address - Street 2:SUITE 1120
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-660-3150
Practice Address - Fax:918-660-3143
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200410110AMedicaid