Provider Demographics
NPI:1629685813
Name:HENDERSON, KRISSI LYNN (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISSI
Middle Name:LYNN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 E 61ST ST STE 101A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1908
Mailing Address - Country:US
Mailing Address - Phone:918-893-3535
Mailing Address - Fax:
Practice Address - Street 1:8316 E 61ST ST STE 101A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1908
Practice Address - Country:US
Practice Address - Phone:918-893-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0073169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily