Provider Demographics
NPI:1295328037
Name:MCDONALD, KRISTINA LEIGHANN (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:LEIGHANN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:MISS
Other - First Name:KRISTINA
Other - Middle Name:LEIGHANN
Other - Last Name:TRAUTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41554 TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-7458
Mailing Address - Country:US
Mailing Address - Phone:405-788-9423
Mailing Address - Fax:
Practice Address - Street 1:1102 W MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1743
Practice Address - Country:US
Practice Address - Phone:405-395-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL-301316163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant