Provider Demographics
NPI:1871887034
Name:BEARDEN, KRISTIN LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LEE
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10019 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6103
Mailing Address - Country:US
Mailing Address - Phone:918-615-5001
Mailing Address - Fax:918-615-5011
Practice Address - Street 1:10019 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6103
Practice Address - Country:US
Practice Address - Phone:918-615-5001
Practice Address - Fax:918-615-5011
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14427183500000X
TX47132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100851520BMedicaid