Provider Demographics
NPI:1568605442
Name:TOWNE, KIMBERLEY KAY (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:KAY
Last Name:TOWNE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:TOWNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:8903 S 198TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-6514
Mailing Address - Country:US
Mailing Address - Phone:918-231-1939
Mailing Address - Fax:
Practice Address - Street 1:1366 SQUAW VALLEY DR
Practice Address - Street 2:UNIT B
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9790
Practice Address - Country:US
Practice Address - Phone:918-231-1939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51903367500000X
TX591457367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered