Provider Demographics
NPI:1316228901
Name:NUNLEY, TRISTA JEANENE
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:JEANENE
Last Name:NUNLEY
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 1:200 WILDEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1440
Mailing Address - Country:US
Mailing Address - Phone:405-219-4486
Mailing Address - Fax:
Practice Address - Street 1:200 WILDEWOOD TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-1440
Practice Address - Country:US
Practice Address - Phone:405-219-4486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical