Healthcare Provider Details

I. General information

NPI: 1174364236
Provider Name (Legal Business Name): NEKOLE OAKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9165 OTIS AVE STE 213
INDIANAPOLIS IN
46216-2316
US

IV. Provider business mailing address

9165 OTIS AVE STE 213
INDIANAPOLIS IN
46216-2316
US

V. Phone/Fax

Practice location:
  • Phone: 317-663-9707
  • Fax:
Mailing address:
  • Phone: 317-663-9707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number28242067A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: