Provider Demographics
NPI:1427470723
Name:ANTWINE, KAMBRI
Entity type:Individual
Prefix:
First Name:KAMBRI
Middle Name:
Last Name:ANTWINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-470-2590
Mailing Address - Fax:405-470-0619
Practice Address - Street 1:9417 N COUNCIL RD STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-6228
Practice Address - Country:US
Practice Address - Phone:405-470-2590
Practice Address - Fax:405-470-0619
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical