Provider Demographics
NPI:1942737374
Name:DAVIS, KIMBERLY (CNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RINGLING
Mailing Address - State:OK
Mailing Address - Zip Code:73456
Mailing Address - Country:US
Mailing Address - Phone:580-662-2316
Mailing Address - Fax:580-662-2113
Practice Address - Street 1:108 S 5TH ST
Practice Address - Street 2:
Practice Address - City:RINGLING
Practice Address - State:OK
Practice Address - Zip Code:73456
Practice Address - Country:US
Practice Address - Phone:580-662-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76248363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care