Provider Demographics
NPI:1881402006
Name:RAY, CRISTA DAWN (LPN)
Entity type:Individual
Prefix:
First Name:CRISTA
Middle Name:DAWN
Last Name:RAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CRISTA
Other - Middle Name:
Other - Last Name:MATLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:23470 NS 416 RD
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-4933
Mailing Address - Country:US
Mailing Address - Phone:918-273-8767
Mailing Address - Fax:
Practice Address - Street 1:23 E ROSS AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-6423
Practice Address - Country:US
Practice Address - Phone:918-227-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0057040164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse