Provider Demographics
NPI:1598233264
Name:DENSMORE, KIMBERLY (RBT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DENSMORE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-4307
Mailing Address - Country:US
Mailing Address - Phone:918-859-9339
Mailing Address - Fax:
Practice Address - Street 1:7170 S BRADEN AVE STE 195
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6324
Practice Address - Country:US
Practice Address - Phone:918-280-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-18-53175247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other