Provider Demographics
NPI:1417235540
Name:CONOVER, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:CONOVER
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 1:10417 FUTURITY DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5731
Mailing Address - Country:US
Mailing Address - Phone:405-209-7415
Mailing Address - Fax:
Practice Address - Street 1:10417 FUTURITY DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5731
Practice Address - Country:US
Practice Address - Phone:405-209-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor