Provider Demographics
NPI:1821449497
Name:UKPSYCH LLC
Entity Type:Organization
Organization Name:UKPSYCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CRADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-834-8610
Mailing Address - Street 1:8988 S SHERIDAN RD STE D2
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5035
Mailing Address - Country:US
Mailing Address - Phone:970-834-8610
Mailing Address - Fax:844-308-5898
Practice Address - Street 1:8988 S SHERIDAN RD STE D2
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5035
Practice Address - Country:US
Practice Address - Phone:970-834-8610
Practice Address - Fax:844-308-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK290812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1821449497Medicaid