Healthcare Provider Details

I. General information

NPI: 1548562325
Provider Name (Legal Business Name): KIMBERLY ROBERTS APRN, CNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 NW 63RD ST
OKLAHOMA CITY OK
73116-3705
US

IV. Provider business mailing address

3620 REDMONT TRCE
EDMOND OK
73034-4012
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-9732
  • Fax:
Mailing address:
  • Phone: 405-816-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberRN80809
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: