Individual
JERRY RAY NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1402 N FLORENCE AVE STE B, CLAREMORE, OK 74017-3159
(918) 608-0380
Mailing address
8056 QUAIL RIDGE RD, CLAREMORE, OK 74019-7504
(918) 619-3833
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/03/2021
Last updated
07/03/2021
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