Provider Demographics
NPI:1609858331
Name:HANIGAR, KIMBERLY K (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:HANIGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-8633
Mailing Address - Country:US
Mailing Address - Phone:405-964-6463
Mailing Address - Fax:405-964-2412
Practice Address - Street 1:704 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-8633
Practice Address - Country:US
Practice Address - Phone:405-964-6463
Practice Address - Fax:405-964-2412
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100126130CMedicaid
OK100126130CMedicaid
OK233714201Medicare PIN