=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104772029
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIE LYNN ROBICHAUX
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2026
-----------------------------------------------------
Last Update Date | 03/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2250 N AIRPORT RD
-----------------------------------------------------
City | WEATHERFORD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73096-3351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-424-7711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 620 N ILLINOIS ST
-----------------------------------------------------
City | WEATHERFORD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73096-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-375-8387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------