Healthcare Provider Details

I. General information

NPI: 1275348179
Provider Name (Legal Business Name): KIMBERLY BURDINE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 ELM AVE RM 201
NORMAN OK
73019-3142
US

IV. Provider business mailing address

14902 PRESTON RD. STE 404 UNIT 374
DALLAS TX
75254
US

V. Phone/Fax

Practice location:
  • Phone: 405-325-2911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number36914
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1481
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: