Provider Demographics
NPI:1538787668
Name:WADLEY, KIMBERLY KAY (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:WADLEY
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-3033
Mailing Address - Country:US
Mailing Address - Phone:806-338-0336
Mailing Address - Fax:
Practice Address - Street 1:1309 N EAST ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-3333
Practice Address - Country:US
Practice Address - Phone:580-338-4638
Practice Address - Fax:580-338-4642
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily