Provider Demographics
NPI:1144866070
Name:PATTERSON, KIMBERLY DAWN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 S 96TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-3926
Mailing Address - Country:US
Mailing Address - Phone:539-292-3577
Mailing Address - Fax:
Practice Address - Street 1:9726 E 42ND ST STE 142
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3626
Practice Address - Country:US
Practice Address - Phone:405-919-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist