Provider Demographics
NPI:1528030970
Name:SELF, KRISTI G (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:G
Last Name:SELF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N BROOKLINE AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3626
Mailing Address - Country:US
Mailing Address - Phone:405-605-8780
Mailing Address - Fax:405-605-8782
Practice Address - Street 1:5100 N BROOKLINE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3623
Practice Address - Country:US
Practice Address - Phone:405-605-8780
Practice Address - Fax:405-605-8782
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18173208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100144570AMedicaid
OK250013313OtherRAILROAD MEDICARE
OK250013313OtherRAILROAD MEDICARE