Healthcare Provider Details

I. General information

NPI: 1588608293
Provider Name (Legal Business Name): KIMBALL N PRATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 24TH AVE SW
NORMAN OK
73069
US

IV. Provider business mailing address

1122 NE 13TH ST ORI 236
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-325-5800
  • Fax:
Mailing address:
  • Phone: 405-325-5800
  • Fax: 405-701-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4301065100
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number26028
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: