Provider Demographics
NPI:1851703128
Name:CRIPPS, KIMBERLY (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CRIPPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-2350
Mailing Address - Country:US
Mailing Address - Phone:580-371-2002
Mailing Address - Fax:580-371-2058
Practice Address - Street 1:714 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-2350
Practice Address - Country:US
Practice Address - Phone:580-371-2002
Practice Address - Fax:580-371-2058
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37D343460704163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7542OtherSO HH
OK7767OtherWE HH
TX011510OtherTX HH