Provider Demographics
NPI:1134829385
Name:EPPERSON, KIMBERLY D (FSP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:D
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:FSP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DARLENE
Other - Last Name:EPPERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA FSP
Mailing Address - Street 1:7010 S YALE AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5743
Mailing Address - Country:US
Mailing Address - Phone:918-245-5565
Mailing Address - Fax:
Practice Address - Street 1:7010 S YALE AVE STE 215
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5743
Practice Address - Country:US
Practice Address - Phone:918-236-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health