Provider Demographics
NPI:1821431891
Name:JERDAN, KIMBERLY RACHEL (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RACHEL
Last Name:JERDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-773-6470
Mailing Address - Fax:405-773-6463
Practice Address - Street 1:5915 W MEMORIAL RD STE 300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2022
Practice Address - Country:US
Practice Address - Phone:405-773-6470
Practice Address - Fax:405-773-6463
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK35118207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology