Individual
TERRY LEE NICKELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2803 SE 44TH ST, OKLAHOMA CITY, OK 73129-8533
(405) 672-1316
(405) 670-2477
Mailing address
PO BOX 95165, OKLAHOMA CITY, OK 73143-5165
(405) 672-1316
(405) 670-2477
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1706
OK
Other
Enumeration date
09/13/2006
Last updated
11/24/2009
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