Provider Demographics
NPI:1720892631
Name:BUTTS, KIMBERLY LEIGH
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LEIGH
Last Name:BUTTS
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 1:3738 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-1222
Mailing Address - Country:US
Mailing Address - Phone:918-633-0066
Mailing Address - Fax:
Practice Address - Street 1:3738 E 4TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-1222
Practice Address - Country:US
Practice Address - Phone:918-633-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty