Healthcare Provider Details

I. General information

NPI: 1326566001
Provider Name (Legal Business Name): MINOR PEDIATRICS KRISTIE MINOR APRN-CNP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29334 N 3950 RD
OCHELATA OK
74051-2485
US

IV. Provider business mailing address

29334 N 3950 RD
OCHELATA OK
74051-2485
US

V. Phone/Fax

Practice location:
  • Phone: 918-637-4891
  • Fax:
Mailing address:
  • Phone: 918-637-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTIE LYNN MINOR
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 918-637-4891