MEDICARE: NICOLE WATKINS

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	163W00000X	Registered Nurse	R0105615	OK

General Provider Information

NPI Number	:	1801739115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE WATKINS

Provider Business Mailing Address
First Line	:	507 S 67TH ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-6958
Country	:	US
Telephone Number	:	918-760-0166
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 S 67TH ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-6958
Country	:	US
Telephone Number	:	918-760-0166
Fax Number	:

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

Provider Enumeration Date	:	04/11/2026
Last Update Date	:	04/11/2026

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Directions to “ NICOLE WATKINS ” Practice Location

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