Provider Demographics
NPI:1750518072
Name:WHICKER, KIMBERLY D (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:WHICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960454
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0454
Mailing Address - Country:US
Mailing Address - Phone:800-684-1598
Mailing Address - Fax:405-844-1794
Practice Address - Street 1:24 NORRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-3541
Practice Address - Country:US
Practice Address - Phone:479-253-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6742207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185539001Medicaid
AR249349YH95Medicare PIN