MEDICARE: KURSTYN JEAN CIANCIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1164129201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURSTYN JEAN CIANCIO

Provider Business Mailing Address
First Line	:	2636 AMY CT
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-9500
Country	:	US
Telephone Number	:	580-216-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N CLASSEN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6016
Country	:	US
Telephone Number	:	405-248-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	02/09/2023

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