Provider Demographics
NPI:1841399904
Name:POTTER-KIMBALL, ROBIN ROWENA (APRN, CNS)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ROWENA
Last Name:POTTER-KIMBALL
Suffix:
Gender:F
Credentials:APRN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 NW 63RD STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116
Mailing Address - Country:US
Mailing Address - Phone:405-848-4682
Mailing Address - Fax:405-849-4683
Practice Address - Street 1:3208 NW 63RD STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-848-4682
Practice Address - Fax:405-849-4683
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR046325364SP0808X
OKR0046323364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK562358678OtherTAX ID NUMBER
OK562358678OtherTAX ID NUMBER