Basic Information
| Provider Information | |||||||||
| NPI: | 1003150459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BATTLE | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748340025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056413437 | ||||||||
| FaxNumber: | 4052415215 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 E 4TH ST | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748342225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056413437 | ||||||||
| FaxNumber: | 4052415215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2012 | ||||||||
| LastUpdateDate: | 03/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.