Provider Demographics
NPI:1760670293
Name:HAVENER, KRISTA NICOLE
Entity Type:Individual
Prefix:MISS
First Name:KRISTA
Middle Name:NICOLE
Last Name:HAVENER
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 1:200 N CHOCTAW AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2624
Mailing Address - Country:US
Mailing Address - Phone:405-262-3203
Mailing Address - Fax:405-262-1331
Practice Address - Street 1:200 N CHOCTAW
Practice Address - Street 2:SUITE 140
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2624
Practice Address - Country:US
Practice Address - Phone:405-262-3209
Practice Address - Fax:405-262-1331
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist