Provider Demographics
NPI:1104787142
Name:BYERS, NICOLAS ANTONIO
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:ANTONIO
Last Name:BYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 W STANLEY DRAPER DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73165-6503
Mailing Address - Country:US
Mailing Address - Phone:405-985-6075
Mailing Address - Fax:
Practice Address - Street 1:11601 W STANLEY DRAPER DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73165-6503
Practice Address - Country:US
Practice Address - Phone:405-985-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKH082340334175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist