Provider Demographics
NPI:1427257617
Name:PITTMAN, KIMBERLEY K (PSYD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:K
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 NW 63RD ST STE 227
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3631
Mailing Address - Country:US
Mailing Address - Phone:405-849-6173
Mailing Address - Fax:405-544-5916
Practice Address - Street 1:3035 NW 63RD ST STE 227
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3631
Practice Address - Country:US
Practice Address - Phone:405-849-6173
Practice Address - Fax:405-544-5916
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1111103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical