Provider Demographics
NPI:1669923702
Name:EPPERLY, KRISTI LYNN
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:EPPERLY
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 1:511 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048-8942
Mailing Address - Country:US
Mailing Address - Phone:405-919-8386
Mailing Address - Fax:
Practice Address - Street 1:10321 N 2274 RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-7521
Practice Address - Country:US
Practice Address - Phone:580-331-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57787164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse