Individual
CRISTY S BURRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FSP
Contact information
Practice address
602 SW 38TH ST, LAWTON, OK 73505-6912
(580) 248-5780
Mailing address
602 SW 38TH ST, LAWTON, OK 73505-6912
(580) 248-5780
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
73-6017987
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
73-6017987
—
OK
Enumeration date
03/27/2019
Last updated
03/27/2019
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