Basic Information
| Provider Information | |||||||||
| NPI: | 1518999887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBER | ||||||||
| FirstName: | KIERSTEN | ||||||||
| MiddleName: | BRIDGET | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 N LINCOLN BLVD | ||||||||
| Address2: | SUITE 2900 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731043252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052711000 | ||||||||
| FaxNumber: | 4052717522 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 N LINCOLN BLVD | ||||||||
| Address2: | SUITE 3400 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731043252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052711000 | ||||||||
| FaxNumber: | 4052717522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | POD212 | OK | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | POD212 | 01 | OK | STATE LICENSE | OTHER |