Individual provider Active NPI

Kristin Lee Wills, D.O.

  • Emergency Medicine Physician
  • Tulsa, OK
National Provider Identifier
1710921929
Registry record updated Aug 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
3995 Issued in OK
Practice address
1923 S Utica Ave
St John Emergency Dept
Tulsa, OK 74104-6520
Phone
(918) 744-3528
Fax
(918) 744-3529
NPI assigned
Jun 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 3995 OK Primary

Addresses

Primary practice location

1923 S Utica Ave
St John Emergency Dept
Tulsa, OK 74104-6520

Mailing address

1923 S Utica Ave
St John Emergency Dept
Tulsa, OK 74104-6520
Phone (918) 744-3528

Other names 1

  • Dr. Kristin Lee Talla Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040804001066 OK Practitioner - Emergency Medicine 8325019185 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
St. John Physicians, Inc CurrentSince May 1, 2010 Accepting new patients
St. John Physicians, Inc. Emergency Medicine CurrentSince May 1, 2010 Accepting new patients
Norstar Emergency Physicians Past Accepting new patients
St John Urgent Care Clinics Inc Past Accepting new patients

Locations

12451 E 100th St N
Owasso, OK 74055
Phone (918) 274-5000

1004 E Bryan Ave
Sapulpa, OK 74066
Phone (918) 224-4280

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660

1717 S Utica Ave
Ste A
Tulsa, OK 74104
Phone (918) 748-1300

1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585

Organizations & group practices 4

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409184000000",
    "number": "1710921929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 S UTICA AVE",
            "address_2": "ST JOHN EMERGENCY DEPT",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741046520",
            "telephone_number": "918-744-3528",
            "fax_number": "918-744-3529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 S UTICA AVE",
            "address_2": "ST JOHN EMERGENCY DEPT",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741046520",
            "telephone_number": "918-744-3528",
            "fax_number": "918-744-3529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLS",
        "first_name": "KRISTIN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2014-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "3995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "TALLA",
            "middle_name": "LEE",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.