Provider Demographics
NPI:1497026702
Name:SWAIN, KIMBERLY MICHELLE
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:SWAIN
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 1:4400 WILL ROGERS PKWY
Mailing Address - Street 2:SUIT 214
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1837
Mailing Address - Country:US
Mailing Address - Phone:405-601-8876
Mailing Address - Fax:405-601-7358
Practice Address - Street 1:4400 WILL ROGERS PKWY
Practice Address - Street 2:SUIT 214
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1837
Practice Address - Country:US
Practice Address - Phone:405-601-8876
Practice Address - Fax:405-601-7358
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK103K00000XMedicaid