MEDICARE: ROBIN R POTTER-KIMBALL APRN P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	R0046325	OK

General Provider Information

NPI Number	:	1952508814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBIN R POTTER-KIMBALL APRN P C

Provider Business Mailing Address
First Line	:	3208 NW 63RD STREET
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116
Country	:	US
Telephone Number	:	405-848-4682
Fax Number	:	405-849-4683

Provider Business Practice Location Address
First Line	:	3208 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3704
Country	:	US
Telephone Number	:	405-286-4350
Fax Number	:	405-286-4361

Authorized Official
Title or Position	:	OWNER
Name	:	ROBIN POTTER KIMBALL
Credential	:	CNS
Telephone Number	:	405-849-4682

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	12/09/2022

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