Provider Demographics
NPI:1184084097
Name:LEWIS, KRISTY (NP)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 SKYLINE CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-3819
Mailing Address - Country:US
Mailing Address - Phone:417-592-7315
Mailing Address - Fax:
Practice Address - Street 1:27371 S 4410 RD
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-7953
Practice Address - Country:US
Practice Address - Phone:918-256-4800
Practice Address - Fax:918-256-9023
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016001662363LF0000X
OKM0113980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily