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NPI Code Detail

MEDICARE: KYMBRYNN NICOLE O'DIAM APRN

MEDICARE: KYMBRYNN NICOLE O'DIAM APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner200856OK

General Provider Information

NPI Number : 1043800196
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYMBRYNN NICOLE O'DIAM APRN
Provider Business Mailing Address
First Line : 101 OKLAHOMA AVE
Second Line :
City : MCALESTER
State : OK
Zip : 74501-7520
Country : US
Telephone Number : 918-423-4900
Fax Number :
Provider Business Practice Location Address
First Line : 101 OKLAHOMA AVE
Second Line :
City : MCALESTER
State : OK
Zip : 74501-7520
Country : US
Telephone Number : 918-423-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2021
Last Update Date : 02/09/2022

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