Elliot Kimball

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

License

H082956414 Issued in OK

Practice address

316 S Midwest Blvd
Midwest City, OK 73110-4642

Phone

(405) 733-5437

Fax

(405) 732-7741

NPI assigned

Jul 28, 2014

Last updated

Jul 28, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mid-del Youth & Family Center, Inc.

  • Community/Behavioral Health Agency
  • Del City, OK
  • NPI 1114099355
  NPD (past)
• Mid-del Youth and Family Center

  • Community/Behavioral Health Agency
  • Midwest City, OK
  • NPI 1932478708
  NPD (past)

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

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406505600000",
    "number": "1912315409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 WELLMAN WAY",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730723705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 S MIDWEST BLVD",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731104642",
            "telephone_number": "405-733-5437",
            "fax_number": "405-732-7741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "ELLIOT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-28",
        "last_updated": "2014-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "OK",
            "license": "H082956414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matheen K Khan, MD
• Shujath A Khan, MD
• Tracy Adelle Kidwell, D.O.
• Nancy Kienka, NP
• Megan Leigh Kilmer
• Cherokee King
• Lalonda Kay King
• Andrew William Kinnamon, PT
• Annie G Kirk, LMSW
• Brenda Kitchen, MA, LPC-C

• Rehabilitation Practitioner in Midwest City, OK
• Providers in Midwest City, OK by specialty
• Rehabilitation Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; 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.