Provider Demographics
NPI:1700587789
Name:DALRYMPLE, KIMBERLY ROCHELLE (IBCLC, CD(DONA))
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROCHELLE
Last Name:DALRYMPLE
Suffix:
Gender:F
Credentials:IBCLC, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 OAK ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-8833
Mailing Address - Country:US
Mailing Address - Phone:580-475-6853
Mailing Address - Fax:
Practice Address - Street 1:306 OAK ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538-8833
Practice Address - Country:US
Practice Address - Phone:580-475-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14701374J00000X
L-310848174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula