Individual
KRISTEN RENEA HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1095 NICKERSON ST, WAYNOKA, OK 73860-1252
(580) 824-0674
(580) 824-0676
Mailing address
PO BOX 135, WAYNOKA, OK 73860-0135
(580) 824-0674
(580) 824-0676
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942334768
—
OK
Enumeration date
06/11/2021
Last updated
06/11/2021
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