Provider Demographics
NPI:1275019598
Name:CALHOUN, KIMBERLY ANNE (APRN-CNP, MSN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:APRN-CNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SW 19TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3052
Mailing Address - Country:US
Mailing Address - Phone:405-492-6799
Mailing Address - Fax:405-595-0579
Practice Address - Street 1:705 SW 19TH ST STE 120
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3052
Practice Address - Country:US
Practice Address - Phone:405-492-6799
Practice Address - Fax:405-595-0579
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK82221363LF0000X
OKR0082221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily