Provider Demographics
NPI:1396482964
Name:KIMMEL, KELLYE DIANE (BSW-SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:KELLYE
Middle Name:DIANE
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:BSW-SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W TECUMSEH RD APT 6114
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1854
Mailing Address - Country:US
Mailing Address - Phone:405-255-9544
Mailing Address - Fax:
Practice Address - Street 1:3700 W TECUMSEH RD APT 6114
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1854
Practice Address - Country:US
Practice Address - Phone:405-255-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker