Provider Demographics
NPI:1801324751
Name:BEEN, KRISTIN JANELL (ATC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:JANELL
Last Name:BEEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 LOVE ST
Mailing Address - Street 2:
Mailing Address - City:POCOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74902-2454
Mailing Address - Country:US
Mailing Address - Phone:918-721-1753
Mailing Address - Fax:
Practice Address - Street 1:3205 JENNY LIND RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7101
Practice Address - Country:US
Practice Address - Phone:479-785-2501
Practice Address - Fax:479-420-3655
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer