Healthcare Provider Details

I. General information

NPI: 1265437909
Provider Name (Legal Business Name): MRS. KRISTI BEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6839 S CANTON AVE
TULSA OK
74136-3402
US

IV. Provider business mailing address

10512 S URBANA AVE
TULSA OK
74137-6247
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-0612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0040929
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0040929
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: