Healthcare Provider Details

I. General information

NPI: 1932095353
Provider Name (Legal Business Name): CHRISTINA ANN UNDERWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISSY ANN UNDERWOOD RN

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

IV. Provider business mailing address

2706 HIGHWAY 75
WETUMKA OK
74883
US

V. Phone/Fax

Practice location:
  • Phone: 918-616-5064
  • Fax: 918-577-4808
Mailing address:
  • Phone: 405-584-0961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR0113528
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: