Healthcare Provider Details

I. General information

NPI: 1750751954
Provider Name (Legal Business Name): KRISTI JO CAGLE APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4418
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE SUITE 280
OKLAHOMA CITY OK
73112-5556
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-3393
  • Fax: 405-945-5493
Mailing address:
  • Phone: 405-949-3393
  • Fax: 405-945-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number94618
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: