| Janice L Kimball | |
|
3000 W Memorial Rd Ste 218 Oklahoma City OK 73120-6103 | |
| (405) 400-9991 | |
| Not Available |
| Full Name | Janice L Kimball |
|---|---|
| Speciality | Clinic/Center |
| Location | 3000 W Memorial Rd Ste 218, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Janice Leigh Kimball (OWNER) |
| Authorized Official Contact | 4054009991 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Janice L Kimball 3000 W Memorial Rd Ste 218 Oklahoma City OK 73120-6103 Ph: (405) 400-9991 | Janice L Kimball 3000 W Memorial Rd Ste 218 Oklahoma City OK 73120-6103 Ph: (405) 400-9991 |
| NPI Number | 1326779240 |
|---|---|
| Provider Enumeration Date | 06/21/2022 |
| Last Update Date | 08/04/2022 |
| Certification Date | 08/04/2022 |
| Medicare PECOS PAC ID | 9638552540 |
|---|---|
| Medicare Enrollment ID | O20220810000527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326779240 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Janice Kimball |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629128301 PECOS PAC ID: 7810051687 Enrollment ID: I20090123000330 |
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