Healthcare Provider Details

I. General information

NPI: 1891872933
Provider Name (Legal Business Name): KIMBERLY S HOVSEPIAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 E RIVER RD
NEWKIRK OK
74647-7517
US

IV. Provider business mailing address

3151 E RIVER RD PO BOX 474
NEWKIRK OK
74647-7517
US

V. Phone/Fax

Practice location:
  • Phone: 580-362-1039
  • Fax: 580-362-2988
Mailing address:
  • Phone: 580-362-1039
  • Fax: 580-362-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1500651
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: