Healthcare Provider Details

I. General information

NPI: 1942026083
Provider Name (Legal Business Name): NICHOLAS WESTON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E CADDO AVE
WILBURTON OK
74578-2622
US

IV. Provider business mailing address

215 E CADDO AVE
WILBURTON OK
74578-2622
US

V. Phone/Fax

Practice location:
  • Phone: 918-448-4814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22107
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: