Healthcare Provider Details

I. General information

NPI: 1699435644
Provider Name (Legal Business Name): KIMBERLEY RENEE SELLERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 S 101ST EAST AVE
TULSA OK
74133-5716
US

IV. Provider business mailing address

30307 E 133RD ST S
COWETA OK
74429-6310
US

V. Phone/Fax

Practice location:
  • Phone: 918-294-4370
  • Fax:
Mailing address:
  • Phone: 918-695-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: