=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801289665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTYN JANELLE ZRENDA D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2015
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 NW EXPRESSWAY STE 815
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-4492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-945-4990
-----------------------------------------------------
Fax | 405-945-4991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 NW EXPRESSWAY STE 815
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-4492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-945-4990
-----------------------------------------------------
Fax | 405-945-4991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 6075
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------