Provider Demographics
NPI:1356829352
Name:BUFFALO, KIMBERLY RENE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENE
Last Name:BUFFALO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-5356
Mailing Address - Country:US
Mailing Address - Phone:918-964-7071
Mailing Address - Fax:800-872-8213
Practice Address - Street 1:2104 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-5356
Practice Address - Country:US
Practice Address - Phone:918-964-7071
Practice Address - Fax:800-872-8213
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0080324163W00000X
OK212781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse