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General NPI Number Information
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NPI Number | 1679598809
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Entity Type | Individual
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Provider Name | KIMBERELY DAWN KMITA CNM, ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 1120 S UTICA AVE STE. G100
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City | TULSA
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State | OK
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Zip | 74104-4012
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Country | US
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Telephone | 918-392-0175
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Fax | 918-392-0176
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Provider Business Mailing Address
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Address Line | 8803 S 101ST EAST AVE STE 205
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City | TULSA
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State | OK
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Zip | 74133-5730
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Country | US
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Telephone | 918-858-0008
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Fax | 918-858-0074
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | R0066134
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 66134
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License Number State | OK
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