Healthcare Provider Details

I. General information

NPI: 1932793130
Provider Name (Legal Business Name): KIMBERLY JUNE REEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MONTE VISTA ST STE A
ADA OK
74820-4675
US

IV. Provider business mailing address

530 N MONTE VISTA ST STE A
ADA OK
74820-4675
US

V. Phone/Fax

Practice location:
  • Phone: 580-310-9510
  • Fax: 580-436-4777
Mailing address:
  • Phone: 580-310-9510
  • Fax: 580-436-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number200092
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: