MEDICARE: KRISTON N AHLEFELD

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1669257895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTON N AHLEFELD

Provider Business Mailing Address
First Line	:	PO BOX 892919
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73189-2919
Country	:	US
Telephone Number	:	405-889-9010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 NW 1ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-5204
Country	:	US
Telephone Number	:	405-889-9010
Fax Number	:

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

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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Directions to “ KRISTON N AHLEFELD ” Practice Location

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