Basic Information
| Provider Information | |||||||||
| NPI: | 1528576105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRIEGER | ||||||||
| FirstName: | COLEEN | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1445 N INDIAN MERIDIAN RD | ||||||||
| Address2: | |||||||||
| City: | COYLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730277412 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 505 N 14TH ST STE C | ||||||||
| Address2: | |||||||||
| City: | PERRY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730775000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803363529 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2018 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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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 | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.