Provider Demographics
NPI:1013151174
Name:KIMBERLY DAVIS, RD/LD, P.C., INC.
Entity type:Organization
Organization Name:KIMBERLY DAVIS, RD/LD, P.C., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:DAVIS-CONIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD/LD
Authorized Official - Phone:405-326-5403
Mailing Address - Street 1:1414 N PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6662
Mailing Address - Country:US
Mailing Address - Phone:405-326-5403
Mailing Address - Fax:405-217-3985
Practice Address - Street 1:1414 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6662
Practice Address - Country:US
Practice Address - Phone:405-326-5403
Practice Address - Fax:405-217-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center