Provider Demographics
NPI:1891261095
Name:EDENS, KRISTINA E
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:E
Last Name:EDENS
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:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:COPAN
Mailing Address - State:OK
Mailing Address - Zip Code:74022-0143
Mailing Address - Country:US
Mailing Address - Phone:918-331-7754
Mailing Address - Fax:
Practice Address - Street 1:114 W DELEWARE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048
Practice Address - Country:US
Practice Address - Phone:918-273-1841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)