Provider Demographics
NPI:1831556612
Name:KIMBERLY EDGMON MD, PLLC
Entity type:Organization
Organization Name:KIMBERLY EDGMON MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-726-8000
Mailing Address - Street 1:2820 N KELLY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3007
Mailing Address - Country:US
Mailing Address - Phone:405-726-8000
Mailing Address - Fax:405-726-8101
Practice Address - Street 1:2820 N KELLY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-3007
Practice Address - Country:US
Practice Address - Phone:405-726-8000
Practice Address - Fax:405-726-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty