Healthcare Provider Details

I. General information

NPI: 1831556612
Provider Name (Legal Business Name): KIMBERLY EDGMON MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 N KELLY AVE SUITE 200
EDMOND OK
73003-3007
US

IV. Provider business mailing address

2820 N KELLY AVE SUITE 200
EDMOND OK
73003-3007
US

V. Phone/Fax

Practice location:
  • Phone: 405-726-8000
  • Fax: 405-726-8101
Mailing address:
  • Phone: 405-726-8000
  • Fax: 405-726-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY EDGMON
Title or Position: OWNER
Credential: MD
Phone: 405-726-8000