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General NPI Number Information
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NPI Number | 1699963264
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Entity Type | Organization
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Legal Business Name | KICKINGBIRD FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 2820 N KELLY AVE SUITE 200
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City | EDMOND
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State | OK
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Zip | 73003-3007
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Country | US
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Telephone | 405-330-1478
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Fax | 405-330-6231
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Provider Business Mailing Address
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Address Line | PO BOX 31266
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City | EDMOND
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State | OK
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Zip | 73003-0022
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Country | US
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Telephone | 405-330-1478
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Fax | 405-330-6231
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY BRIAN JONES
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Credential | M.D.
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Telephone | 405-330-1478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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