Provider Demographics
NPI:1427608330
Name:PARKER, NICHOLAS DWAYNE
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DWAYNE
Last Name:PARKER
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 1:47 N BAY LN
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6592
Mailing Address - Country:US
Mailing Address - Phone:918-698-6425
Mailing Address - Fax:
Practice Address - Street 1:10306 E 114TH PL S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-3205
Practice Address - Country:US
Practice Address - Phone:918-698-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider