Provider Demographics
NPI:1528576105
Name:KRIEGER, COLEEN RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:RAE
Last Name:KRIEGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 N INDIAN MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:COYLE
Mailing Address - State:OK
Mailing Address - Zip Code:73027-7412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 N 14TH ST STE C
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5000
Practice Address - Country:US
Practice Address - Phone:580-336-3529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant