Healthcare Provider Details

I. General information

NPI: 1821449497
Provider Name (Legal Business Name): UKPSYCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8988 S SHERIDAN RD STE D2
TULSA OK
74133-5035
US

IV. Provider business mailing address

8988 S SHERIDAN RD STE D2
TULSA OK
74133-5035
US

V. Phone/Fax

Practice location:
  • Phone: 970-834-8610
  • Fax: 844-308-5898
Mailing address:
  • Phone: 970-834-8610
  • Fax: 844-308-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29081
License Number StateOK

VIII. Authorized Official

Name: DR. KATRINA MARIA CRADER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 970-834-8610