Provider Demographics
NPI:1952508814
Name:ROBIN R POTTER-KIMBALL APRN P C
Entity Type:Organization
Organization Name:ROBIN R POTTER-KIMBALL APRN P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:CNS
Authorized Official - Phone:405-849-4682
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 ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3704
Practice Address - Country:US
Practice Address - Phone:405-286-4350
Practice Address - Fax:405-286-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0046325163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP85665Medicare UPIN