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General NPI Number Information
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NPI Number | 1104055730
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Entity Type | Individual
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Provider Name | NICK CARROLL DO
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Gender | Male
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 2448 E 81ST ST STE 400
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City | TULSA
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State | OK
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Zip | 74137-4294
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Country | US
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Telephone | 918-710-4222
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Fax | 539-867-3947
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Provider Business Mailing Address
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Address Line | 7912 E. 31ST COURT
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City | TULSA
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State | OK
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Zip | 74145-1334
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Country | US
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Telephone | 918-743-8200
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Fax | 918-743-8609
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4745
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License Number State | OK
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