Provider Demographics
NPI:1831624394
Name:RIMMER, KENDALL
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:RIMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 W NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-3016
Mailing Address - Country:US
Mailing Address - Phone:408-466-6698
Mailing Address - Fax:
Practice Address - Street 1:2224 W NEWTON ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-3016
Practice Address - Country:US
Practice Address - Phone:408-466-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator