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General NPI Number Information
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NPI Number | 1568079176
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Entity Type | Individual
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Provider Name | CONNER NICHOLS
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Gender | Male
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 2010 BOREN BLVD
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City | SEMINOLE
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State | OK
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Zip | 74868-2050
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Country | US
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Telephone | 53-824-5074
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Fax | 405-382-5269
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Provider Business Mailing Address
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Address Line | PO BOX 189
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City | ARDMORE
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State | OK
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Zip | 73402-0189
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Country | US
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Telephone | 580-319-7305
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Fax | 580-319-7328
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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