Provider Demographics
NPI:1891934238
Name:VAILS, KRISTA DANIELLE (BS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:DANIELLE
Last Name:VAILS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2042
Mailing Address - Country:US
Mailing Address - Phone:918-277-2087
Mailing Address - Fax:
Practice Address - Street 1:108 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2042
Practice Address - Country:US
Practice Address - Phone:918-277-2087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education