Individual
SAMUEL KIMBROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1701 RENAISSANCE BLVD STE 110, EDMOND, OK 73013-3084
(405) 844-4978
Mailing address
301 N WALKER AVE APT 8101, OKLAHOMA CITY, OK 73102-1871
(580) 721-0409
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
03/21/2023
Last updated
03/23/2023
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