Individual
KIMYATTA HISHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10505 N MILITARY AVE, OKLAHOMA CITY, OK 73114-5226
(405) 473-3849
Mailing address
10505 N MILITARY AVE, OKLAHOMA CITY, OK 73114-5226
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
101YA0400X
OK
Other
Enumeration date
11/25/2013
Last updated
11/25/2013
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