Healthcare Provider Details

I. General information

NPI: 1003307935
Provider Name (Legal Business Name): MARY KATLIN NIXON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2018
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 RC LUTTRELL DR STE 200
NORMAN OK
73072-9005
US

IV. Provider business mailing address

901 N PORTER AVE
NORMAN OK
73071-6482
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-1264
  • Fax:
Mailing address:
  • Phone: 405-307-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number33858
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: