Provider Demographics
NPI:1629209168
Name:ZACHERY, KIMBERLY YVETTE (BHRS/MED)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:YVETTE
Last Name:ZACHERY
Suffix:
Gender:F
Credentials:BHRS/MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 NW 118TH TERR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120
Mailing Address - Country:US
Mailing Address - Phone:405-749-1175
Mailing Address - Fax:
Practice Address - Street 1:2220 NW 118TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7807
Practice Address - Country:US
Practice Address - Phone:405-749-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator