DR. KIMBERLEE VAN WILSON (NPI# 1306134929) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306134929 |
| Entity Type | Individual |
| Full Name | DR. KIMBERLEE VAN WILSON |
| Credential | D.O. |
| Practice Address |
4851 Integris Parkway Edmond OK 73034 |
| Mailing Address |
5300 N Independence Ave Ste 280 Oklahoma City OK 73112-5555 |
| Practice Telephone | 4052162500 |
| Practice Fax Number | 4052162501 |
| Mailing Telephone | 4052162500 |
| Mailing Fax Number | 4052162501 |
| Enumeration Date | 2011-07-17 |
| Last Update Date | 2019-03-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
5840 | OK | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
5840 | OK | Allopathic & Osteopathic Physicians |
| Street Address |
4851 INTEGRIS PARKWAY |
| City | EDMOND |
| State | OK |
| Zip Code | 73034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952863912 | Diamond Turner | Case Manager/Care Coordinator | 4851 Integris Parkway, Edmond, OK 73034 | 2019-04-01 |
| 1548727209 | Arcadia Trails Integris Center for Addiction Recovery LLC | Substance Abuse Rehabilitation Facility | 4851 Integris Parkway, Edmond, OK 73034 | 2019-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306447172 | Saints Medical Group, LLC | Family Medicine | 2749 Progressive Dr, Suite B, Edmond, OK 73034 | 2020-11-06 |
| 1194339861 | Susan Haesook Kim | Pharmacist | 1400 2nd St, Edmod, Edmond, OK 73034 | 2020-09-01 |
| 1821616038 | Aaron Michael Gowens | Specialist/Technologist | 015 Wantland Hall 100 University Dr., Edmond, OK 73034 | 2020-07-14 |
| 1043834849 | Paddington Place Lcc | Intermediate Care Facility, Mental Illness | 3225 French Park Drive, Suite 6, Edmond, OK 73034 | 2020-06-08 |
| 1083254932 | Purpose Healthcare Inc | Psychologist | 301 South Blvd, Suite 117, Edmond, OK 73034 | 2020-01-08 |
| 1740773662 | Healthcare Express, LLP | Family Medicine | 2300 E 2nd St, Edmond, OK 73034 | 2018-06-14 |
| 1427555713 | Sara Nicole Smith | Specialist/Technologist | 100 N University Drive, Attn: Athletic Training Room, Edmond, OK 73034 | 2018-04-12 |
| 1619475084 | Carissa Leigh Brackelsberg | Chiropractor | 3709 E 2nd St, Edmond, OK 73034 | 2018-01-31 |
| 1760996177 | Laurel Michelle Glendening | Physical Therapist | 3531 River Wood Lane, Edmond, OK 73034 | 2017-11-21 |
| 1134643380 | Keith S Quinn | Dentist | 3008 Peaceful Ln, Edmond, OK 73034 | 2017-07-31 |
| Find all providers in zip 73034 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497223846 | Mind and Body Medical Clinic | Psychiatry & Neurology | 2216 Nw 164th St Ste A, Edmond, OK 73013-9078 | 2018-11-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316124605 | Jorg Johannes Pahl | Psychiatry & Neurology | 3909 N Classen Blvd Ste 200, Oklahoma City, OK 73118-2650 | 2008-01-29 |
| 1164070314 | Lowell James Robertson | Psychiatry & Neurology | 1111 W 17th St, Tulsa, OK 74107-1886 | 2019-08-30 |
| 1588229033 | State of Oklahoma Osu Center for Health Sciences | Psychiatry & Neurology | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2019-05-09 |
| 1437683729 | F Clark Sauls, Md | Psychiatry & Neurology | 723 W Randolph Ave, Suite 6, Enid, OK 73701-3826 | 2017-04-13 |
| 1184981144 | Dustin O'leath Hayes | Psychiatry & Neurology | 817 S Elm Pl, Suite C, Broken Arrow, OK 74012-5369 | 2012-04-16 |
| 1942488986 | Jane Phillips Specialty Physicians | Psychiatry & Neurology | 226 Se Debell Ave, Bldg B, Bartlesville, OK 74006-2343 | 2008-02-01 |
| 1467659953 | Samuel Gene Martin | Psychiatry & Neurology | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2007-06-28 |
| 1801966338 | Gayathri Dasharathy | Psychiatry & Neurology | 3300 Nw Expressway, Oklahoma City, OK 73112-4418 | 2006-11-09 |
| 1831281070 | Nicasio S Gutierrez Jr. | Psychiatry & Neurology | 909 Alameda St, Norman, OK 73071-5229 | 2006-09-28 |
| 1528168721 | Gita - Pujari II | Psychiatry & Neurology | 921 Ne 13th St, 116c, Oklahoma City, OK 73104-5007 | 2006-09-25 |
| Find all providers with the same taxonomy | ||||
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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.