Provider Demographics
NPI:1336588326
Name:WILSON, NICOLE APRIL (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:APRIL
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CHILDRENS AVE STE 2E
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4637
Mailing Address - Country:US
Mailing Address - Phone:405-271-5789
Mailing Address - Fax:405-271-1643
Practice Address - Street 1:1200 CHILDRENS AVE STE 2E
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-5789
Practice Address - Fax:405-271-1643
Is Sole Proprietor?:No
Enumeration Date:2013-06-23
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK459232086S0120X
NY3044152086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018008652OtherSTATE OF MISSOURI
NY304415OtherSTATE OF NEW YORK
NY06055958Medicaid