Provider Demographics
NPI:1033435912
Name:DAVIS, KIMBERLY NICHOLE (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NICHOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:NICHOLE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3400 E FRANK PHILLIPS BLVD STE 702
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2443
Mailing Address - Country:US
Mailing Address - Phone:918-335-5000
Mailing Address - Fax:918-331-2506
Practice Address - Street 1:3400 E FRANK PHILLIPS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2439
Practice Address - Country:US
Practice Address - Phone:918-331-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013021817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine