Healthcare Provider Details

I. General information

NPI: 1013072644
Provider Name (Legal Business Name): KIMBERLY K HANIGAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S 8TH STREET
MCLOUD OK
74851-0530
US

IV. Provider business mailing address

PO BOX 530 704 S 8TH STREET
MCLOUD OK
74851-0530
US

V. Phone/Fax

Practice location:
  • Phone: 405-964-6463
  • Fax: 405-964-2412
Mailing address:
  • Phone: 405-964-6463
  • Fax: 405-964-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY K HANIGAR
Title or Position: OWNER
Credential: MD
Phone: 405-964-6463