Individual
KIMYATTA BRENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 S TUCKER DR, TULSA, OK 74104-9700
(918) 631-2562
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
207524
OK
367500000X
Certified Registered Nurse Anesthetist
AP128262
TX
Other
Enumeration date
04/28/2014
Last updated
07/11/2022
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