Basic Information
| Provider Information | |||||||||
| NPI: | 1437670676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STARBUCK | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3433 NW 56TH ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059473341 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3433 NW 56TH ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059473341 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 102648 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.