1306335252 NPI number — MRS. KRISTEN NICOLE LAIL I M.ED, RBT

Table of content: MRS. KRISTEN NICOLE LAIL I M.ED, RBT (NPI 1306335252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306335252 NPI number — MRS. KRISTEN NICOLE LAIL I M.ED, RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAIL
Provider First Name:
KRISTEN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
I
Provider Credential Text:
M.ED, RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'CONNOR
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
M.ED
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306335252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1924 NW 176TH TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73012-6981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-290-7952
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2505 SE LEE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73501-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-854-1072
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2018

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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