Provider Demographics
NPI:1659154441
Name:WHITE, KRISTIN K
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:K
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202639 E COUNTY ROAD 42
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-5442
Mailing Address - Country:US
Mailing Address - Phone:580-254-5322
Mailing Address - Fax:
Practice Address - Street 1:1521 NE HWY 54
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-1247
Practice Address - Country:US
Practice Address - Phone:580-338-5851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist