Healthcare Provider Details

I. General information

NPI: 1497152615
Provider Name (Legal Business Name): MS. KRISTINE ANNE RUNFOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10159 E 11TH ST STE 201
TULSA OK
74128-3058
US

IV. Provider business mailing address

10159 E 11TH ST STE 201
TULSA OK
74128-3058
US

V. Phone/Fax

Practice location:
  • Phone: 918-384-4547
  • Fax: 918-384-4699
Mailing address:
  • Phone: 918-384-4547
  • Fax: 918-384-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7756
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: