Healthcare Provider Details

I. General information

NPI: 1003463324
Provider Name (Legal Business Name): KRYSTAL LYNN RACHAL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W MEMORIAL RD
OKLAHOMA CITY OK
73142-2015
US

IV. Provider business mailing address

5700 NW 135TH ST STE 200
OKLAHOMA CITY OK
73142-5940
US

V. Phone/Fax

Practice location:
  • Phone: 615-988-6335
  • Fax:
Mailing address:
  • Phone: 405-548-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95944
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: