Healthcare Provider Details

I. General information

NPI: 1922767631
Provider Name (Legal Business Name): KRYSTLE RENEE O'DOWD APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 SE ADAMS BLVD
BARTLESVILLE OK
74006-8960
US

IV. Provider business mailing address

7128 S CANTON AVE
TULSA OK
74136-6303
US

V. Phone/Fax

Practice location:
  • Phone: 918-331-0550
  • Fax:
Mailing address:
  • Phone: 918-695-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number206196
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: