Provider Demographics
NPI:1871554808
Name:KNOX, KIM B (NP)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:B
Last Name:KNOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:BINKLEY
Other - Last Name:DEVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3801 NW 166TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-9279
Mailing Address - Country:US
Mailing Address - Phone:405-359-1122
Mailing Address - Fax:405-359-1100
Practice Address - Street 1:3801 NW 166TH ST STE 4
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-9279
Practice Address - Country:US
Practice Address - Phone:405-359-1122
Practice Address - Fax:405-359-1100
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0047398363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100136730BMedicaid
OK100136730AMedicaid
OKS49676Medicare UPIN
OK248427802Medicare PIN
OK243328004Medicare PIN
OK100136730AMedicaid