Healthcare Provider Details

I. General information

NPI: 1669740205
Provider Name (Legal Business Name): KIMBERLY KAY MCKENZIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2011
Last Update Date: 12/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E COURT ST
ATOKA OK
74525-2047
US

IV. Provider business mailing address

PO BOX 278
LEHIGH OK
74556-0278
US

V. Phone/Fax

Practice location:
  • Phone: 580-364-6839
  • Fax:
Mailing address:
  • Phone: 580-364-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR72976
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: