KIMBERLY ANN KELLY-LORENZ (NPI# 1093127979) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093127979 |
| Entity Type | Individual |
| Full Name | KIMBERLY ANN KELLY-LORENZ |
| Practice Address |
163 Mohawk Dr Canadian OK 74425-9747 |
| Practice Telephone | 9183395800 |
| Practice Fax Number | 9183395801 |
| Mailing Telephone | 9183395800 |
| Mailing Fax Number | 9183395801 |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2014-05-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Street Address |
163 MOHAWK DR |
| City | CANADIAN |
| State | OK |
| Zip Code | 74425-9747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710015904 | Canadian Public School | Public Health or Welfare | 1 Belt Ave, Canadian, OK 74425 | 2007-03-01 |
| 1992163547 | Michael Edward Shuman Sr. | Community Health Worker | 69 Arrowhead Loop, Canadian, OK 74425 | 2016-02-10 |
| 1366724924 | Lee Rain Wallin | Community Health Worker | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2011-09-09 |
| 1205317278 | Jennifer Ruth Howell | Case Manager/Care Coordinator | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2018-08-27 |
| 1821524109 | Mandy Jerome | Counselor | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2017-05-05 |
| 1457887739 | Crystal Lamb | Counselor | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2017-05-05 |
| 1518324250 | Charles Alan Flucard | Community Health Worker | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2016-01-26 |
| 1417356015 | Heather Miller | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-19 |
| 1699174284 | Derry Hallmark | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-19 |
| 1962811802 | Dylan Victor Leslie | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-05 |
| Find all providers in zip 74425 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730339771 | Narconon of Oklahoma, Inc | Substance Abuse Rehabilitation Facility | Hc 67 Box 5, Canadian, OK 74425-9700 | 2008-09-26 |
| 1417356015 | Heather Miller | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-19 |
| 1699174284 | Derry Hallmark | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-19 |
| 1962811802 | Dylan Victor Leslie | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-05 |
| 1790199263 | Ryan Donald Pointek | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-06-12 |
| 1386056109 | Nellabeth Alexander-richmond | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-05-28 |
| 1932511789 | William Patrick Lott | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-05-28 |
| 1770995516 | Liberty Maria Burkhart | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-05-28 |
| 1023420098 | Justin Dwayne Ross | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-05-27 |
| 1194137463 | Kimberly Irene Cooper | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-05-21 |
| Find all providers in CANADIAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.