Healthcare Provider Details

I. General information

NPI: 1477576320
Provider Name (Legal Business Name): KRISTA KAY GRINSTEAD R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 STATE ST
BARTLESVILLE OK
74006-2932
US

IV. Provider business mailing address

3500 STATE ST
BARTLESVILLE OK
74006-2932
US

V. Phone/Fax

Practice location:
  • Phone: 918-331-1770
  • Fax: 918-331-1328
Mailing address:
  • Phone: 918-331-1770
  • Fax: 918-331-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1024
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: