Individual
DR. KRISTY PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3517 W OWEN K GARRIOTT RD, SUITE FOUR, ENID, OK 73703-4952
(580) 233-5553
Mailing address
PO BOX 3494, ENID, OK 73702-3494
(580) 233-5553
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19458
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100253950A
—
OK
Enumeration date
10/12/2006
Last updated
08/19/2009
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