| Kimberly Boren | |
|
1306 W Broadway St Ardmore OK 73401-2838 | |
| (918) 973-2451 | |
| Not Available |
| Full Name | Kimberly Boren |
|---|---|
| Speciality | Social Worker |
| Location | 1306 W Broadway St, Ardmore, Oklahoma |
| Authorized Official Name and Position | Kimberly Husting (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9189732451 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kimberly Boren 1421 3rd Ave Sw Ardmore OK 73401-3217 Ph: (918) 973-2451 | Kimberly Boren 1306 W Broadway St Ardmore OK 73401-2838 Ph: (918) 973-2451 |
| NPI Number | 1881388049 |
|---|---|
| Provider Enumeration Date | 06/08/2023 |
| Last Update Date | 10/15/2023 |
| Certification Date | 10/15/2023 |
| Medicare PECOS PAC ID | 5991169609 |
|---|---|
| Medicare Enrollment ID | O20230914000505 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881388049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kimberly Nicole Husting |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275900318 PECOS PAC ID: 5496133365 Enrollment ID: I20220606000591 |
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