Individual
NICHOLAS D DEBOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2488 E 81ST ST STE 290, TULSA, OK 74137-4265
(918) 494-2665
(918) 927-3201
Mailing address
2488 E 81ST ST STE 290, TULSA, OK 74137-4265
(918) 927-3226
(918) 927-3193
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
2194
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200472630A
—
OK
Enumeration date
12/23/2012
Last updated
10/08/2020
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