Provider Demographics
NPI:1710921929
Name:WILLS, KRISTIN LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LEE
Last Name:WILLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:LEE
Other - Last Name:TALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:ST JOHN EMERGENCY DEPT
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-744-3528
Mailing Address - Fax:918-744-3529
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:ST JOHN EMERGENCY DEPT
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-744-3528
Practice Address - Fax:918-744-3529
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3995207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243714319Medicare PIN