Kimberly Dawn Richardson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

58407 Issued in OK

Practice address

9213 NE 10TH St
Midwest City, OK 73130-1317

Phone

(405) 264-7627

Fax

(405) 455-3342

NPI assigned

May 16, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Home Away From Home Adult Day Services LLC

  • Adult Day Care Clinic/Center
  • Midwest City, OK
  • NPI 1598389454
  NPD (past) Authorized official
• Home Away From Home Behavioral Health & Wellness Center

  • Addiction (Substance Use Disorder) Counselor
  • Midwest City, OK
  • NPI 1720901994
  NPD (past) Authorized official

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

{
    "created_epoch": "1557964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557964800000",
    "number": "1568028355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9213 NE 10TH ST",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731301317",
            "telephone_number": "405-264-7627",
            "fax_number": "405-455-3342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9213 NE 10TH ST",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731301317",
            "telephone_number": "405-264-7627",
            "fax_number": "405-455-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "KIMBERLY",
        "middle_name": "DAWN",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-16",
        "last_updated": "2019-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OK",
            "license": "58407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADULT DAY HEALTH CENTER",
            "identifier": "463977830",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlos A Rhodes
• Chance Rice, PTA
• Richard Hollander D.D.S.
• Bobbie Richardson
• Donald Richardson
• Porsha Lynn Richardson, NURSE PRACTITIONER
• Taylor Richardson
• Holly Marie Richison, M.S CFY-SLP
• Tiffany Q Rideau
• Irving Riley, PT

• Licensed Practical Nurse in Midwest City, OK
• Providers in Midwest City, OK by specialty
• Licensed Practical Nurse in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2019; 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.