Healthcare Provider Details

I. General information

NPI: 1184286734
Provider Name (Legal Business Name): KRISTYN MICHELLE DIXON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KRISTYN MICHELLE BAKER

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 S HARVARD AVE
TULSA OK
74135-4402
US

IV. Provider business mailing address

3105 S HARVARD AVE
TULSA OK
74135-4402
US

V. Phone/Fax

Practice location:
  • Phone: 918-508-7601
  • Fax: 918-508-7603
Mailing address:
  • Phone: 918-508-7601
  • Fax: 918-508-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5210
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: