Healthcare Provider Details

I. General information

NPI: 1679598809
Provider Name (Legal Business Name): KIMBERELY DAWN KMITA CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERELY D MURRY CNM, ARNP

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE STE. G100
TULSA OK
74104-4012
US

IV. Provider business mailing address

8803 S 101ST EAST AVE STE 205
TULSA OK
74133-5730
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-0175
  • Fax: 918-392-0176
Mailing address:
  • Phone: 918-858-0008
  • Fax: 918-858-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number66134
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR0066134
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: