Individual
KRYSTAL ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1815 E 15TH ST, TULSA, OK 74104-4610
(918) 809-6205
Mailing address
PO BOX 4769, TULSA, OK 74159-0769
(918) 809-6205
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
215355
OK
Other
Enumeration date
09/26/2023
Last updated
09/26/2023
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