Individual
KIMMY RENEA BRECKENRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5304 SW TYLER AVE, LAWTON, OK 73505-5750
(580) 351-8520
Mailing address
5304 SW TYLER AVE, LAWTON, OK 73505-5750
(580) 351-8520
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
70881
OK
Other
Enumeration date
12/16/2019
Last updated
12/16/2019
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