Provider Demographics
NPI:1760742282
Name:SMITH, KRISTINA LEE (DO)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9645 RIVERSIDE PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7427
Mailing Address - Country:US
Mailing Address - Phone:918-209-5170
Mailing Address - Fax:918-209-5187
Practice Address - Street 1:9645 RIVERSIDE PKWY STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7427
Practice Address - Country:US
Practice Address - Phone:918-209-5170
Practice Address - Fax:918-209-5187
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK747279OtherMEDICARE
OK200494810BMedicaid