Provider Demographics
NPI:1205255726
Name:BARNETT, KRISTEN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BARNETT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LEE
Other - Last Name:DARROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34488 W 331ST ST S
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-5070
Mailing Address - Country:US
Mailing Address - Phone:918-688-9223
Mailing Address - Fax:
Practice Address - Street 1:306 E. PETERSON ST.
Practice Address - Street 2:
Practice Address - City:OILTON
Practice Address - State:OK
Practice Address - Zip Code:74052
Practice Address - Country:US
Practice Address - Phone:918-688-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100635210 AMedicaid