Provider Demographics
NPI:1497152615
Name:RUNFOLA, KRISTINE ANNE
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:ANNE
Last Name:RUNFOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10159 E 11TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-3058
Mailing Address - Country:US
Mailing Address - Phone:918-384-4547
Mailing Address - Fax:918-384-4699
Practice Address - Street 1:10159 E 11TH ST STE 201
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-3058
Practice Address - Country:US
Practice Address - Phone:918-384-4547
Practice Address - Fax:918-384-4699
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 1041S0200X
OK77561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool