Kymbrynn Nicole O'Diam, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

200856 Issued in OK

Practice address

101 Oklahoma Ave
McAlester, OK 74501-7520

Phone

(918) 423-4900

NPI assigned

Jan 22, 2021

Last updated

Feb 9, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kymbrynn Nicole Henneke Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1043800196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 OKLAHOMA AVE",
            "city": "MCALESTER",
            "state": "OK",
            "postal_code": "745017520",
            "telephone_number": "918-423-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 OKLAHOMA AVE",
            "city": "MCALESTER",
            "state": "OK",
            "postal_code": "745017520",
            "telephone_number": "918-423-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DIAM",
        "first_name": "KYMBRYNN",
        "middle_name": "NICOLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-22",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "200856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYMBRYNN",
            "last_name": "HENNEKE",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amy Nohelty, BS, MS
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• Cierra Brooklyn Toshali Sue Nutt, RD
• Bruce E. O'Brien, M.D.
• Emily Elizabeth Ogden, APRN-CNP
• Ok4 McAlester Opco LLC (Walnut Grove Living center)
• Okc Dental Health Associates, P.C. (MyDentist-McAlester)
• Oklahoma Cancer Specialists and Research Institute LLC
• Oklahoma CVS Pharmacy, L.L.C. (CVS Pharmacy # 10275)

• Family Nurse Practitioner in McAlester, OK
• Providers in McAlester, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.