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General NPI Number Information
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NPI Number | 1609828680
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Entity Type | Individual
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Provider Name | KIMBERLY KAY HUTTON MD
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 4500 S 129TH EAST AVE SUITE 191
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City | TULSA
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State | OK
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Zip | 74134-5801
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Country | US
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Telephone | 918-392-4544
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Fax | 918-779-7425
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Provider Business Mailing Address
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Address Line | 4500 S 129TH E AVE, SUITE 191
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City | TULSA
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State | OK
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Zip | 74134-5891
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Country | US
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Telephone | 918-392-4544
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Fax | 918-779-7425
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21187
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License Number State | OK
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