Individual
KIMELLA DENISE GLOVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1215 NE 59TH ST, OKLAHOMA CITY, OK 73111-7403
(405) 630-4329
Mailing address
1215 NE 59TH ST, OKLAHOMA CITY, OK 73111-7403
(405) 630-4329
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200123000A
—
OK
Enumeration date
05/05/2011
Last updated
05/05/2011
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