1437246857 NPI number — MS. KIMERA JANICE CAREL DPH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437246857 NPI number — MS. KIMERA JANICE CAREL DPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAREL
Provider First Name:
KIMERA
Provider Middle Name:
JANICE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437246857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7638 NW FOLKSTONE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-585-5401
Provider Business Mailing Address Fax Number:
580-510-7033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 WEST GORE BOULEVARD
Provider Second Line Business Practice Location Address:
GREAT PLAINS PHARMACY
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-585-5401
Provider Business Practice Location Address Fax Number:
580-510-7033
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  9752 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100749570R , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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