Provider Demographics
NPI:1467287425
Name:GOSE, KIMBERLY (LPN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GOSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 EW 6 RD
Mailing Address - Street 2:
Mailing Address - City:WANN
Mailing Address - State:OK
Mailing Address - Zip Code:74083-1043
Mailing Address - Country:US
Mailing Address - Phone:918-440-1878
Mailing Address - Fax:
Practice Address - Street 1:705 S VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-4439
Practice Address - Country:US
Practice Address - Phone:844-458-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0064726164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse