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General NPI Number Information
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NPI Number | 1932209558
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Entity Type | Individual
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Provider Name | KIMBERLY ANNE RUSSELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | VAMC 921 NE 13TH STREET 2A-137
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104
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Country | US
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Telephone | 405-456-3896
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Fax | 405-456-1504
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Provider Business Mailing Address
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Address Line | 921 NE 13TH ST # 2A-133
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5007
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Country | US
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Telephone | 405-456-4367
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Fax | 405-456-1504
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA744
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 744
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License Number State | OK
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