Healthcare Provider Details

I. General information

NPI: 1003516311
Provider Name (Legal Business Name): KRISTINE MARIE THOMPSON APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD STE 215
OKLAHOMA CITY OK
73120-8361
US

IV. Provider business mailing address

4140 W MEMORIAL RD STE 215
OKLAHOMA CITY OK
73120-8361
US

V. Phone/Fax

Practice location:
  • Phone: 405-242-4030
  • Fax: 405-242-4031
Mailing address:
  • Phone: 405-242-4030
  • Fax: 405-242-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number211637
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number211637
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number211637
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: