MEDICARE: MS. KRISTIN ANN KRAKOWSKI P.A.-C

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
1	363AM0700X	Medical Physician Assistant	1768	OK

General Provider Information

NPI Number	:	1124278189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN ANN KRAKOWSKI P.A.-C

Provider Business Mailing Address
First Line	:	4505 MEMORIAL CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-5004
Country	:	US
Telephone Number	:	405-749-7099
Fax Number	:	405-755-9237

Provider Business Practice Location Address
First Line	:	4505 MEMORIAL CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-5004
Country	:	US
Telephone Number	:	405-749-7099
Fax Number	:	405-216-5872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2008
Last Update Date	:	03/13/2017

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