MEDICARE: KIMBERLY DAWN PATTERSON

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
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1144866070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DAWN PATTERSON

Provider Business Mailing Address
First Line	:	2252 S 96TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-3926
Country	:	US
Telephone Number	:	539-292-3577
Fax Number	:

Provider Business Practice Location Address
First Line	:	9726 E 42ND ST STE 142
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-3626
Country	:	US
Telephone Number	:	405-919-8781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	11/26/2019

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Directions to “ KIMBERLY DAWN PATTERSON ” Practice Location

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