Provider Demographics
NPI:1194080499
Name:NELSON, DAMARCUS ROCHEON (APRN)
Entity type:Individual
Prefix:
First Name:DAMARCUS
Middle Name:ROCHEON
Last Name:NELSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-0660
Mailing Address - Country:US
Mailing Address - Phone:405-373-2400
Mailing Address - Fax:405-373-4400
Practice Address - Street 1:11109 SURREY HILLS BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8155
Practice Address - Country:US
Practice Address - Phone:405-373-2400
Practice Address - Fax:405-373-4400
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK90736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily