Kristen Leann Boldra
Individual provider Active NPI Peer Specialist · Jay, OK
NPI 1104518372 · NPPES record last updated May 24, 2023
Key facts
- NPI
- 1104518372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- Practice address
- 1015 W Washbourne St
Jay, OK 74346-4205 - Phone
- (918) 308-5513
- Fax
- (918) 253-6645
- NPI assigned
- May 24, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Yes |
Addresses
Primary practice location
1015 W Washbourne St
Jay, OK 74346-4205
Mailing address
1015 W Washbourne St
Jay, OK 74346-4205
Phone (918) 308-5513
Other names
- Kristen Leann Garr
Other providers in Jay, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.