MEDICARE: PROF. CHAROLETTE ANN MYLES-NIXON PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	115677	OK

General Provider Information

NPI Number	:	1861718702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. CHAROLETTE ANN MYLES-NIXON PH.D

Provider Business Mailing Address
First Line	:	PO BOX 60004
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73146-0004
Country	:	US
Telephone Number	:	405-708-2689
Fax Number	:

Provider Business Practice Location Address
First Line	:	2231 NW 16TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-4926
Country	:	US
Telephone Number	:	405-708-2689
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	04/16/2010

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