Healthcare Provider Details

I. General information

NPI: 1447887997
Provider Name (Legal Business Name): KIMBERLY DAWN HARRISON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30011 E STATE HIGHWAY 51
COWETA OK
74429-7681
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-486-2161
  • Fax: 918-486-3135
Mailing address:
  • Phone: 888-247-0125
  • Fax: 918-502-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7354
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: