1407017296 NPI number — MRS. KRISTINA ANN BERRY C.O.T.A.

Table of content: MRS. KRISTINA ANN BERRY C.O.T.A. (NPI 1407017296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407017296 NPI number — MRS. KRISTINA ANN BERRY C.O.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRY
Provider First Name:
KRISTINA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.O.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUNAWAY
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.O.T.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407017296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10815 BLUE SKY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDWEST CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73130-2121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-708-2947
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 N SANTA FE AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73116-9126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-840-2903
Provider Business Practice Location Address Fax Number:
405-840-3256
Provider Enumeration Date:
06/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  763 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com