Provider Demographics
NPI:1447467972
Name:SHORT, KIM E (ARNP, CPNP)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:E
Last Name:SHORT
Suffix:
Gender:F
Credentials:ARNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 E QUAIL AVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2536
Mailing Address - Country:US
Mailing Address - Phone:580-774-0910
Mailing Address - Fax:
Practice Address - Street 1:3030 CUSTER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-9117
Practice Address - Country:US
Practice Address - Phone:580-323-2100
Practice Address - Fax:580-323-2282
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 43045 B0063683363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics