Individual provider Active NPI

Kristin Ann Krakowski, P.A.-C

  • Medical Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1124278189
Registry record updated Mar 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1768 Issued in OK
Practice address
4505 Memorial Cir
Oklahoma City, OK 73142-5004
Phone
(405) 749-7099
Fax
(405) 216-5872
NPI assigned
Sep 26, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1768 OK Primary

Addresses

Primary practice location

4505 Memorial Cir
Oklahoma City, OK 73142-5004

Mailing address

4505 Memorial Cir
Oklahoma City, OK 73142-5004
Phone (405) 749-7099

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091212000144 OK Practitioner - Physician Assistant 9234279878 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Logan County, Inc CurrentSince Nov 25, 2013 Accepting new patients
Carnegie Tri-County Municipal Hospital Management, Inc Past Accepting new patients

Locations

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

Interoperability endpoints

  • Direct secure messaging: kkrakowski408218@directc.mercy.net

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489363200000",
    "number": "1124278189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4505 MEMORIAL CIR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731425004",
            "telephone_number": "405-749-7099",
            "fax_number": "405-755-9237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4505 MEMORIAL CIR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731425004",
            "telephone_number": "405-749-7099",
            "fax_number": "405-216-5872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAKOWSKI",
        "first_name": "KRISTIN",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-26",
        "last_updated": "2017-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "1768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.