MEDICARE: ROBIN ROWENA POTTER-KIMBALL APRN, CNS

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	R046325	OK
2	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	R0046323	OK

General Provider Information

NPI Number	:	1841399904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN ROWENA POTTER-KIMBALL APRN, CNS

Provider Business Mailing Address
First Line	:	3208 NW 63RD STREET
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116
Country	:	US
Telephone Number	:	405-848-4682
Fax Number	:	405-849-4683

Provider Business Practice Location Address
First Line	:	3208 NW 63RD STREET
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116
Country	:	US
Telephone Number	:	405-848-4682
Fax Number	:	405-849-4683

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	06/15/2021

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