KRISTIN HOLETZKY (NPI# 1942810197) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942810197 |
| Entity Type | Individual |
| Full Name | KRISTIN HOLETZKY |
| Practice Address |
224 S Chestnut Ave Moore OK 73160-5223 |
| Mailing Address |
224 S Chestnut Ave Ste 100 Moore OK 73160-5223 |
| Practice Telephone | 4053430986 |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2020-08-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
3198 | OK | Allopathic & Osteopathic Physicians |
| Street Address |
224 S CHESTNUT AVE |
| City | MOORE |
| State | OK |
| Zip Code | 73160-5223 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689224453 | Krystin Lorg I | Pharmacist | 224 S Chestnut Ave, Moore, OK 73160-5223 | 2019-09-13 |
| 1720685852 | Dessirea Knox | Dietetic Technician, Registered | 224 S Chestnut Ave, Moore, OK 73160-5223 | 2020-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225678576 | Crystal Amanda Pitts | Student in an Organized Health Care Education/Training Program | 628 Allison Ln, Moore, OK 73160 | 2020-01-14 |
| 1982247623 | Tammie Lee Haworth | Occupational Therapy Assistant | Quest, 400 N Eastern Ave, Moore, OK 73160 | 2019-10-25 |
| 1477102580 | Php Management Group, LLC | Non-Pharmacy Dispensing Site | 1110 Magnolia Court, Moore, OK 73160 | 2019-09-11 |
| 1477117893 | Pharmology Moore LLC | Pharmacy | 1280 N Eastern Ave, Suite F, Moore, OK 73160 | 2019-05-01 |
| 1154891943 | Leah Cordell | Nurse Practitioner | 1280 North Eastern Ave., Suite F, Moore, OK 73160 | 2018-12-05 |
| 1467962332 | Healthcare Express, LLP | Clinic/Center | 551 Se 4th Street, Moore, OK 73160 | 2017-10-05 |
| 1306379557 | Dicarlo Venegas | Behavior Technician | 716 Wood Hollow Ln, Moore, OK 73160 | 2017-04-05 |
| 1073050167 | Tyron Dorrell Cosby Sr. | Case Manager/Care Coordinator | 1416 Penn Ln., Moore, OK 73160 | 2017-01-26 |
| 1326592650 | Kristin Kelley | Counselor | 1113 S Avery Dr, Moore, OK 73160 | 2016-08-03 |
| 1376912600 | Allison Kay Griffiths | Counselor | 9501 S. I-35 Service Rd, Apt 1504, Moore, OK 73160 | 2015-09-16 |
| Find all providers in zip 73160 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932560760 | Robert Darryl Fisher | Family Medicine | 2203 E Wilshire Blvd, Oklahoma City, OK 73111-8604 | 2016-03-07 |
| 1932591419 | Sitesource Medical, LLC | Family Medicine | 324 N Robinson Ave, Oklahoma City, OK 73102-6416 | 2015-02-20 |
| 1699025973 | Great Salt Plains Health Center, Inc. | Family Medicine | 619 Front Street, Medford, OK 73759-1209 | 2012-09-14 |
| 1447543798 | House Call Physicians, Inc | Family Medicine | 3456 Nw 172nd Ter, Edmond, OK 73012-7098 | 2011-05-19 |
| 1639406325 | Leslie Ann Masters | Family Medicine | 8172 S Lewis Ave Ste D, Tulsa, OK 74137-1248 | 2009-11-17 |
| 1487817375 | Brad Alan Liston | Family Medicine | 1908 N 14th St Ste 204, Ponca City, OK 74601-2039 | 2008-07-09 |
| 1962537902 | Gary Erle Johnston | Family Medicine | 53468 Mineral Springs Rd, Hodgen, OK 74939-3064 | 2007-02-22 |
| 1659441228 | Terrance Patrick Mcdermott | Family Medicine | 2536 Sw 29th Street, Mcdermott Clinic, Oklahoma City, OK 73119 | 2006-11-09 |
| 1861436677 | Thomas Ray Crow | Family Medicine | 9170 Us Hwy 70, Waurika, OK 73573 | 2006-06-15 |
| 1699761981 | Larry Dean Sumner | Family Medicine | 204 Woodlawn Ave, Tahlequah, OK 74464-3318 | 2005-09-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.