Healthcare Provider Details

I. General information

NPI: 1497570105
Provider Name (Legal Business Name): KRISTEN MARIE MONROE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE STE 401
TULSA OK
74136-7806
US

IV. Provider business mailing address

6465 S YALE AVE STE 401
TULSA OK
74136-7806
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-3154
  • Fax: 918-582-3593
Mailing address:
  • Phone: 918-582-3154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220913
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: