Healthcare Provider Details

I. General information

NPI: 1144637026
Provider Name (Legal Business Name): KRISTY MEEKS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2014
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E MAIN ST
DAVIS OK
73030-1905
US

IV. Provider business mailing address

321 E. MAIN ST
DAVIS OK
73030-1905
US

V. Phone/Fax

Practice location:
  • Phone: 580-247-9718
  • Fax: 866-682-7623
Mailing address:
  • Phone: 580-247-9718
  • Fax: 866-682-7623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR00 67403
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number833049
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number67403
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: