MEDICARE: MRS. KIMBERLY ANN RICHARDSON H.I.S.

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	237700000X	Hearing Instrument Specialist	981	OK

General Provider Information

NPI Number	:	1467786376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ANN RICHARDSON H.I.S.

Provider Business Mailing Address
First Line	:	9640 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2714
Country	:	US
Telephone Number	:	405-753-1935
Fax Number	:	405-753-1938

Provider Business Practice Location Address
First Line	:	9640 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2714
Country	:	US
Telephone Number	:	405-753-1935
Fax Number	:	405-753-1938

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

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	09/26/2012

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