Provider Demographics
NPI:1881303774
Name:PIERCE, KRYSTLE DIANNE
Entity type:Individual
Prefix:MISS
First Name:KRYSTLE
Middle Name:DIANNE
Last Name:PIERCE
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 1:229 SW 87TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-8416
Mailing Address - Country:US
Mailing Address - Phone:405-659-4125
Mailing Address - Fax:
Practice Address - Street 1:1414 SW 89TH ST STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6312
Practice Address - Country:US
Practice Address - Phone:405-676-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator