Provider Demographics
NPI:1013726512
Name:CHRISTIAN, RILEY JOANN
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:JOANN
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-4547
Mailing Address - Country:US
Mailing Address - Phone:918-829-5780
Mailing Address - Fax:
Practice Address - Street 1:6128 E 38TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5832
Practice Address - Country:US
Practice Address - Phone:918-779-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1053317883175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist