Provider Demographics
NPI:1801394101
Name:ROGERS, KRISTINA (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5834
Mailing Address - Country:US
Mailing Address - Phone:918-940-8500
Mailing Address - Fax:918-940-8399
Practice Address - Street 1:10210 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5834
Practice Address - Country:US
Practice Address - Phone:918-940-8500
Practice Address - Fax:918-940-8399
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109407363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200758530AMedicaid