Provider Demographics
NPI:1639893340
Name:TOLAND, KRYSTAL NAYDEAN
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:NAYDEAN
Last Name:TOLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:NAYDEAN
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13435 S 65TH ST E
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3056
Mailing Address - Country:US
Mailing Address - Phone:918-219-3153
Mailing Address - Fax:
Practice Address - Street 1:13435 S 65TH ST E
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3056
Practice Address - Country:US
Practice Address - Phone:918-219-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37V290501206376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty