Healthcare Provider Details

I. General information

NPI: 1427032085
Provider Name (Legal Business Name): KIM A WRIGHT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S TREATY RD
MIAMI OK
74354-5327
US

IV. Provider business mailing address

111 S TREATY RD
MIAMI OK
74354-5327
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-1511
  • Fax: 918-542-7374
Mailing address:
  • Phone: 918-540-1511
  • Fax: 918-542-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2000148148
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: