Individual
MS. KIMBERLY ANNE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
VAMC 921 NE 13TH STREET, 2A-137, OKLAHOMA CITY, OK 73104
(405) 456-3896
(405) 456-1504
Mailing address
921 NE 13TH ST # 2A-133, OKLAHOMA CITY, OK 73104-5007
(405) 456-4367
(405) 456-1504
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA744
OK
363AM0700X
Medical Physician Assistant
Primary
744
OK
Other
Enumeration date
09/24/2006
Last updated
10/06/2021
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