Provider Demographics
NPI:1295230209
Name:FRY, KRISTI NICOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:NICOLE
Last Name:FRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KRISTI
Other - Middle Name:NICOLE
Other - Last Name:COAKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 8190
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-8190
Mailing Address - Country:US
Mailing Address - Phone:580-379-6650
Mailing Address - Fax:580-379-6659
Practice Address - Street 1:205 S PARK LN
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5755
Practice Address - Country:US
Practice Address - Phone:580-379-6650
Practice Address - Fax:580-379-6659
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200767360AMedicaid