Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2713 | OK |
NPI | 1063485464 |
---|---|
Provider Name | Ms. Kristi C. Williamson |
First Address | Broken Bow, OK 74728-9418 |
Second Address | Idabel, OK 74745-7337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 08/07/2007 |