Provider Demographics
NPI:1366224172
Name:CUNNINGHAM, KRYSTIN LEIGH
Entity type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:LEIGH
Last Name:CUNNINGHAM
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 1:927 BULLFINCH RD
Mailing Address - Street 2:
Mailing Address - City:RUFE
Mailing Address - State:OK
Mailing Address - Zip Code:74755-5012
Mailing Address - Country:US
Mailing Address - Phone:580-433-3399
Mailing Address - Fax:
Practice Address - Street 1:2000 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7353
Practice Address - Country:US
Practice Address - Phone:580-286-6639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator