Provider Demographics
NPI:1932340478
Name:ALLEN, KIMBERLY A (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 NW 9TH ST STE 6200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1017
Mailing Address - Country:US
Mailing Address - Phone:405-272-7677
Mailing Address - Fax:405-231-3783
Practice Address - Street 1:608 NW 9TH ST STE 6200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1017
Practice Address - Country:US
Practice Address - Phone:405-272-7677
Practice Address - Fax:405-231-3783
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRO64944363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP56234Medicare UPIN