Healthcare Provider Details

I. General information

NPI: 1538394291
Provider Name (Legal Business Name): MONICA REICKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA NALL

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SW LEE BLVD
LAWTON OK
73501-5711
US

IV. Provider business mailing address

3401 W GORE BLVD
LAWTON OK
73505-6332
US

V. Phone/Fax

Practice location:
  • Phone: 580-250-6541
  • Fax: 580-250-6543
Mailing address:
  • Phone: 580-355-8620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27184
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME113551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: