Provider Demographics
NPI:1326318668
Name:JAMES, KRYSTIN CHERIE
Entity Type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:CHERIE
Last Name:JAMES
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:RR 1 BOX 1565
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-9752
Mailing Address - Country:US
Mailing Address - Phone:918-575-4649
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 1565
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-9752
Practice Address - Country:US
Practice Address - Phone:918-575-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health