Provider Demographics
NPI:1942320684
Name:TENPENNY, KRISTOPHER (PA)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:
Last Name:TENPENNY
Suffix:
Gender:M
Credentials:PA
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 12093
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-2093
Mailing Address - Country:US
Mailing Address - Phone:405-816-4031
Mailing Address - Fax:
Practice Address - Street 1:205 S ACADEMY RD
Practice Address - Street 2:SUITE D
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-8727
Practice Address - Country:US
Practice Address - Phone:405-282-9449
Practice Address - Fax:405-282-5321
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA1310363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical