Healthcare Provider Details

I. General information

NPI: 1699601567
Provider Name (Legal Business Name): KRISTIN CASEY LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 S MEMORIAL DR
TULSA OK
74133-6914
US

IV. Provider business mailing address

10506 S MEMORIAL DR
TULSA OK
74133-6914
US

V. Phone/Fax

Practice location:
  • Phone: 918-369-3200
  • Fax: 918-369-3209
Mailing address:
  • Phone: 918-369-3200
  • Fax: 918-369-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0136807
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: