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NPI Code Detail

MEDICARE: CRISTY DAWN PETERS

MEDICARE: CRISTY DAWN PETERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorOK

General Provider Information

NPI Number : 1053950741
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRISTY DAWN PETERS
Provider Business Mailing Address
First Line : 1303 S FULTON AVE
Second Line :
City : TULSA
State : OK
Zip : 74112-6319
Country : US
Telephone Number : 715-418-3959
Fax Number :
Provider Business Practice Location Address
First Line : 2000 N CLASSEN BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-6016
Country : US
Telephone Number : 405-248-9333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2019
Last Update Date : 12/30/2019

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Directions to “ CRISTY DAWN PETERS ” Practice Location

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