Individual
JEARLYN KAY NICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1151 S BELMONT AVE, SUITE 101, OKMULGEE, OK 74447-6307
(918) 759-2200
(918) 759-2206
Mailing address
1805 SLEEPY HOLLOW RD, OKMULGEE, OK 74447-7112
(918) 759-2200
(918) 759-2206
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
ROO46187
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033222401
MEDICARE NPI
OK
Enumeration date
08/17/2006
Last updated
07/07/2010
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