Provider Demographics
NPI:1326162926
Name:PICKARD, KRISTIN D (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:PICKARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3347
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:918-488-6010
Practice Address - Street 1:11212 E 48TH ST
Practice Address - Street 2:WARREN CLINIC
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5806
Practice Address - Country:US
Practice Address - Phone:918-556-3000
Practice Address - Fax:918-556-7066
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200103480AMedicaid
OK242719102Medicare PIN