Individual
MISS KIMBERLY W KANIATOBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1308 CRADDUCK RD, ADA, OK 74820
(580) 332-3699
(580) 421-9828
Mailing address
P.O. BOX 2311, ADA, OK 74820
(580) 920-5149
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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