MEDICARE: NICOLE DINGLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1023994621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DINGLE

Provider Business Mailing Address
First Line	:	103 W 11TH ST
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-2909
Country	:	US
Telephone Number	:	918-640-9405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1629 S MAIN ST STE A
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-5368
Country	:	US
Telephone Number	:	918-557-4496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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Directions to “ NICOLE DINGLE ” Practice Location

Language	Start Address	Practice Location

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