Provider Demographics
NPI:1922767631
Name:O'DOWD, KRYSTLE RENEE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:RENEE
Last Name:O'DOWD
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 1:7128 S CANTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6303
Mailing Address - Country:US
Mailing Address - Phone:918-695-9294
Mailing Address - Fax:
Practice Address - Street 1:6006 SE ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8960
Practice Address - Country:US
Practice Address - Phone:918-331-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK206196363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner