Healthcare Provider Details

I. General information

NPI: 1841399904
Provider Name (Legal Business Name): ROBIN ROWENA POTTER-KIMBALL APRN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 NW 63RD STREET
OKLAHOMA CITY OK
73116
US

IV. Provider business mailing address

3208 NW 63RD STREET
OKLAHOMA CITY OK
73116
US

V. Phone/Fax

Practice location:
  • Phone: 405-848-4682
  • Fax: 405-849-4683
Mailing address:
  • Phone: 405-848-4682
  • Fax: 405-849-4683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR046325
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR0046323
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: