Provider Demographics
NPI:1154734994
Name:NICKERSON, MONA JEAN (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MONA
Middle Name:JEAN
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:MRS
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:902 ARLINGTON CTR
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2883
Mailing Address - Country:US
Mailing Address - Phone:580-272-0025
Mailing Address - Fax:580-272-5669
Practice Address - Street 1:721 BETTER NOW PLZ
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2279
Practice Address - Country:US
Practice Address - Phone:580-272-0025
Practice Address - Fax:580-272-5669
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK96054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily