Provider Demographics
NPI:1245582782
Name:NELSON, KIMBERLY HICKS
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:HICKS
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 891921
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-1921
Mailing Address - Country:US
Mailing Address - Phone:405-922-3022
Mailing Address - Fax:
Practice Address - Street 1:864 OAKLAWN DR
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-7496
Practice Address - Country:US
Practice Address - Phone:405-922-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional