Healthcare Provider Details

I. General information

NPI: 1730989187
Provider Name (Legal Business Name): CHERRON NICOLE TAYLOR FNP, AGACNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 E BRYAN AVE
SAPULPA OK
74066-4513
US

IV. Provider business mailing address

855 N 256 RD
MOUNDS OK
74047-5389
US

V. Phone/Fax

Practice location:
  • Phone: 918-224-4280
  • Fax:
Mailing address:
  • Phone: 918-810-4926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR0107563
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0107563
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0107563
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: