Provider Demographics
NPI:1194018580
Name:HARTSELL, CHRYSTI ALAINE
Entity Type:Individual
Prefix:
First Name:CHRYSTI
Middle Name:ALAINE
Last Name:HARTSELL
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 1:308 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-3106
Mailing Address - Country:US
Mailing Address - Phone:580-371-7344
Mailing Address - Fax:
Practice Address - Street 1:308 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-3106
Practice Address - Country:US
Practice Address - Phone:580-371-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37T010041107172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker