Healthcare Provider Details

I. General information

NPI: 1336228683
Provider Name (Legal Business Name): KRISTY LYNNE PRYCE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SE WASHINGTON BLVD
BARTLESVILLE OK
74006-7135
US

IV. Provider business mailing address

16863 E 636 RD
INOLA OK
74036-3423
US

V. Phone/Fax

Practice location:
  • Phone: 918-335-1111
  • Fax: 918-335-1119
Mailing address:
  • Phone: 918-693-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2785
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: