Healthcare Provider Details

I. General information

NPI: 1942162250
Provider Name (Legal Business Name): NICHOLAS HOBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 W KENOSHA ST
BROKEN ARROW OK
74012-8948
US

IV. Provider business mailing address

3501 W KENOSHA ST
BROKEN ARROW OK
74012-8948
US

V. Phone/Fax

Practice location:
  • Phone: 918-994-2764
  • Fax:
Mailing address:
  • Phone: 918-994-2764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: