Provider Demographics
NPI:1386011443
Name:DOUGHTY, KIMBERLEY GAYLE
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:GAYLE
Last Name:DOUGHTY
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 1:5028 SE REDBUD PL
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-8399
Mailing Address - Country:US
Mailing Address - Phone:580-512-4139
Mailing Address - Fax:
Practice Address - Street 1:215 SE WARWICK WAY
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-6368
Practice Address - Country:US
Practice Address - Phone:580-248-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist