Provider Demographics
NPI:1891353819
Name:FORD, KRISTY DAWN (MS)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:DAWN
Last Name:FORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 W MCGILL CIR
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-4309
Mailing Address - Country:US
Mailing Address - Phone:918-490-0217
Mailing Address - Fax:580-371-2056
Practice Address - Street 1:801 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-2351
Practice Address - Country:US
Practice Address - Phone:580-371-3776
Practice Address - Fax:580-371-2056
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional