Healthcare Provider Details

I. General information

NPI: 1245900737
Provider Name (Legal Business Name): WHITNIE HOLTEN-NICKEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WHITNIE HOLTEN

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W 17TH ST
TULSA OK
74107-1886
US

IV. Provider business mailing address

1111 W 17TH ST
TULSA OK
74107-1886
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-1972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8683
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: