Individual
KIMBERLEY DIANE JARVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11637 NS 3580 RD, PRAGUE, OK 74864-6479
(405) 812-8898
Mailing address
11637 NS 3580 RD, PRAGUE, OK 74864-6479
(405) 812-8898
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11131969
SELF
—
Enumeration date
01/16/2022
Last updated
05/11/2026
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