Healthcare Provider Details

I. General information

NPI: 1104648500
Provider Name (Legal Business Name): KRISTIN STRONG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N PORTLAND AVE STE 600
OKLAHOMA CITY OK
73112-2090
US

IV. Provider business mailing address

13200 MAPLEWOOD AVE
OKLAHOMA CITY OK
73120
US

V. Phone/Fax

Practice location:
  • Phone: 405-713-9940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: