Healthcare Provider Details

I. General information

NPI: 1467786376
Provider Name (Legal Business Name): KIMBERLY ANN RICHARDSON H.I.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 W I 35 FRONTAGE RD
EDMOND OK
73034-7398
US

IV. Provider business mailing address

1117 W I 35 FRONTAGE RD
EDMOND OK
73034-7398
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-3219
  • Fax: 405-330-5537
Mailing address:
  • Phone: 405-757-3219
  • Fax: 405-330-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number981
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: