MEDICARE: KRISTIN PURDY

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	224900000X	Mastectomy Fitter

General Provider Information

NPI Number	:	1639963358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN PURDY

Provider Business Mailing Address
First Line	:	5232 E 69TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3407
Country	:	US
Telephone Number	:	918-361-9306
Fax Number	:

Provider Business Practice Location Address
First Line	:	5232 E 69TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3407
Country	:	US
Telephone Number	:	918-361-9306
Fax Number	:

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

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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Directions to “ KRISTIN PURDY ” Practice Location

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