Provider Demographics
NPI:1013688936
Name:PUENTE, KRISTEN (RD, LD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:PUENTE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:PUENTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD
Mailing Address - Street 1:11312 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-0208
Mailing Address - Country:US
Mailing Address - Phone:405-981-6574
Mailing Address - Fax:
Practice Address - Street 1:1200 CHILDRENS AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2584133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered