Individual
KRISTY ANN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
428 S MUSTANG RD, YUKON, OK 73099-6754
(405) 577-5477
Mailing address
428 S MUSTANG RD, YUKON, OK 73099-6754
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/19/2010
Last updated
04/19/2010
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