Provider Demographics
NPI:1295192490
Name:LEOPARD, KIMBERLEY (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:LEOPARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12327 S 134TH ST W
Mailing Address - Street 2:
Mailing Address - City:OKTAHA
Mailing Address - State:OK
Mailing Address - Zip Code:74450-1902
Mailing Address - Country:US
Mailing Address - Phone:918-913-2073
Mailing Address - Fax:
Practice Address - Street 1:12327 S 134TH ST W
Practice Address - Street 2:
Practice Address - City:OKTAHA
Practice Address - State:OK
Practice Address - Zip Code:74450-1902
Practice Address - Country:US
Practice Address - Phone:918-913-2073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0044991164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse