Provider Demographics
NPI:1225465768
Name:KIMBALL, ELIZABETH ANN (APN FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:APN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 E STATE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-1453
Mailing Address - Country:US
Mailing Address - Phone:580-227-3721
Mailing Address - Fax:580-227-1382
Practice Address - Street 1:523 E STATE RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-1453
Practice Address - Country:US
Practice Address - Phone:580-227-3721
Practice Address - Fax:580-227-1382
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0112653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily