Basic Information
| Provider Information | |||||||||
| NPI: | 1669923702 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EPPERLY | ||||||||
| FirstName: | KRISTI | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 E 2ND ST | ||||||||
| Address2: | |||||||||
| City: | HYDRO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730488942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059198386 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10321 N 2274 RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736017521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803313300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2016 | ||||||||
| LastUpdateDate: | 10/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 57787 | OK | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.