NPIMap

Individual provider Active NPI

Elizabeth Ann Kimball, APN FNP-BC

  • Family Nurse Practitioner
  • Fairview, OK
National Provider Identifier
1225465768
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0112653 Issued in OK
Practice address
523 E State Rd
Fairview, OK 73737-1453
Phone
(580) 227-3721
Fax
(580) 227-1382
NPI assigned
Sep 30, 2013
Last updated
Jun 10, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0112653 OK Primary

Addresses

Primary practice location

523 E State Rd
Fairview, OK 73737-1453

Mailing address

523 E State Rd
Fairview, OK 73737-1453
Phone (580) 227-3721

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151222001883 OK Practitioner - Nurse Practitioner 9133420896 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Regional Medical Center AuthorityGroup PAC ID 4183943186, shared by 4 NPIs, 4 clinicians

Practice addresses (Care Compare)

523 E State Rd
Fairview, OK 73737-1453
Phone (580) 227-3721

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0112653OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Regional Medical Center Authority CurrentSince Oct 1, 2015 Accepting new patients
Fairview Regional Medical Center Authority Current Accepting new patients
Fairview Regional Medical Center Authority Current Accepting new patients
Fairview Regional Medical Center Authority CurrentSince Oct 1, 2015 Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

519 E State Rd
Fairview, OK 73737
Phone (580) 227-1334

523 E State Rd
Fairview, OK 73737
Phone (580) 227-1334

Interoperability endpoints

  • Direct secure messaging: ekimball112682@direct-ehr-ssmhc.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1380499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402358400000",
    "number": "1225465768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 E STATE RD",
            "city": "FAIRVIEW",
            "state": "OK",
            "postal_code": "737371453",
            "telephone_number": "580-227-3721",
            "fax_number": "580-227-1382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 E STATE RD",
            "city": "FAIRVIEW",
            "state": "OK",
            "postal_code": "737371453",
            "telephone_number": "580-227-3721",
            "fax_number": "580-227-1382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "credential": "APN FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-30",
        "last_updated": "2014-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "0112653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairview, OK

Sources for this page

Verify at the official NPI Registry.