Healthcare Provider Details

I. General information

NPI: 1417539578
Provider Name (Legal Business Name): MELISSA NICHOLE OLCOTT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 E 12TH ST
TULSA OK
74120-5407
US

IV. Provider business mailing address

4023 S 18TH ST
FORT SMITH AR
72901-7515
US

V. Phone/Fax

Practice location:
  • Phone: 918-588-8888
  • Fax:
Mailing address:
  • Phone: 479-353-1502
  • 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 Code2084P0800X
TaxonomyPsychiatry Physician
License Number7764
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: