Healthcare Provider Details

I. General information

NPI: 1013688936
Provider Name (Legal Business Name): KRISTEN PUENTE RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN PUENTE RD, LD

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

11312 NW 8TH ST
YUKON OK
73099-0208
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4700
  • Fax:
Mailing address:
  • Phone: 405-981-6574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2584
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: