Healthcare Provider Details

I. General information

NPI: 1891090320
Provider Name (Legal Business Name): KRISTY L WITZKE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 N MAY AVE STE C
OKLAHOMA CITY OK
73112-4282
US

IV. Provider business mailing address

5820 N MAY AVE STE C
OKLAHOMA CITY OK
73112-4282
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-8377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3684
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: