1770559940 NPI number — MRS. KIMBERLY LYNN BRIGUCCIA PT

Table of content: MRS. KIMBERLY LYNN BRIGUCCIA PT (NPI 1770559940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770559940 NPI number — MRS. KIMBERLY LYNN BRIGUCCIA PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIGUCCIA
Provider First Name:
KIMBERLY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEAN
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770559940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 W MAIN STREET
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
JENKS
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-298-2381
Provider Business Mailing Address Fax Number:
918-298-2357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 W MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
JENKS
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-298-2381
Provider Business Practice Location Address Fax Number:
918-298-2357
Provider Enumeration Date:
02/27/2006

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: 225100000X , with the licence number:  PT3690 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT1490 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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