Provider Demographics
NPI:1114391315
Name:HESTAND, KIMBERLY YVETTE (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:YVETTE
Last Name:HESTAND
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-1436
Mailing Address - Country:US
Mailing Address - Phone:580-688-2800
Mailing Address - Fax:580-688-2193
Practice Address - Street 1:400 E SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550
Practice Address - Country:US
Practice Address - Phone:580-688-2800
Practice Address - Fax:580-688-2193
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK85865363L00000X
OKF1015324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily