Provider Demographics
NPI:1437209723
Name:SPEAKS, KIMBERLY A (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:SPEAKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2254 W. ROGERS BLVD
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-3909
Mailing Address - Country:US
Mailing Address - Phone:918-895-9353
Mailing Address - Fax:918-895-9354
Practice Address - Street 1:2254 W. ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-3909
Practice Address - Country:US
Practice Address - Phone:918-895-9353
Practice Address - Fax:918-895-9354
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45974363LF0000X
OK100405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200419730AMedicaid
KSQ75768Medicare UPIN
KS200419730AMedicaid