Provider Demographics
NPI:1457618613
Name:MARTIN, KRISTY KAY (APRN-CNS)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:KAY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 S YALE AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7823
Mailing Address - Country:US
Mailing Address - Phone:918-481-2760
Mailing Address - Fax:918-481-2775
Practice Address - Street 1:6465 S YALE AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7823
Practice Address - Country:US
Practice Address - Phone:918-481-2760
Practice Address - Fax:918-481-2775
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0057565364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200428170AMedicaid
OKOKA104441Medicare PIN