Provider Demographics
NPI:1326566001
Name:MINOR PEDIATRICS KRISTIE MINOR APRN-CNP PLLC
Entity Type:Organization
Organization Name:MINOR PEDIATRICS KRISTIE MINOR APRN-CNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:918-637-4891
Mailing Address - Street 1:29334 N 3950 RD
Mailing Address - Street 2:
Mailing Address - City:OCHELATA
Mailing Address - State:OK
Mailing Address - Zip Code:74051-2485
Mailing Address - Country:US
Mailing Address - Phone:918-637-4891
Mailing Address - Fax:
Practice Address - Street 1:29334 N 3950 RD
Practice Address - Street 2:
Practice Address - City:OCHELATA
Practice Address - State:OK
Practice Address - Zip Code:74051-2485
Practice Address - Country:US
Practice Address - Phone:918-637-4891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty