Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 104100000X | Social Worker |
NPI | 1003150459 |
---|---|
Provider Name | Ms. Kimberly Dawn Battle |
First Address | Chandler, OK 74834-0025 |
Second Address | Chandler, OK 74834-2225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2012 |
Last Update Date | 24/03/2015 |