Healthcare Provider Details

I. General information

NPI: 1023302007
Provider Name (Legal Business Name): NICOLE PAOLA MATHES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE VERA

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W BOISE CIR STE 160
BROKEN ARROW OK
74012-4932
US

IV. Provider business mailing address

1923 S UTICA AVE
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 918-994-9166
  • Fax: 918-403-6306
Mailing address:
  • Phone: 918-403-7065
  • Fax: 918-744-2946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS3238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: