Provider Demographics
NPI:1841766474
Name:TREADWELL, KIMBER ALEXIS
Entity Type:Individual
Prefix:MS
First Name:KIMBER
Middle Name:ALEXIS
Last Name:TREADWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-6232
Mailing Address - Country:US
Mailing Address - Phone:580-305-2502
Mailing Address - Fax:
Practice Address - Street 1:1904 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-6232
Practice Address - Country:US
Practice Address - Phone:580-305-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator