Healthcare Provider Details

I. General information

NPI: 1689196727
Provider Name (Legal Business Name): MRS. KRISTEN SHERIE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 04/28/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 S SHERIDAN RD
TULSA OK
74145-5712
US

IV. Provider business mailing address

4930 S SHERIDAN RD
TULSA OK
74145-5712
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-4008
  • Fax:
Mailing address:
  • Phone: 918-392-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10682
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: