MEDICARE: SHERYL NICKS

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	363LA2200X	Adult Health Nurse Practitioner	AG07200164	OK

General Provider Information

NPI Number	:	1033863352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL NICKS

Provider Business Mailing Address
First Line	:	1232 SW 89TH ST STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9110
Country	:	US
Telephone Number	:	888-495-2138
Fax Number	:

Provider Business Practice Location Address
First Line	:	1232 SW 89TH ST STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9110
Country	:	US
Telephone Number	:	888-495-2138
Fax Number	:

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

Provider Enumeration Date	:	02/06/2022
Last Update Date	:	09/23/2022

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Directions to “ SHERYL NICKS ” Practice Location

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