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NPI Code Detail

MEDICARE: MS. NICOLE R COSSAART M.D.

MEDICARE: MS. NICOLE R COSSAART M.D.
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
1207RP1001XPulmonary Disease Physician22862OK
2207RC0200XCritical Care Medicine (Internal Medicine) Physician22862OK
3207PE0004XEmergency Medical Services (Emergency Medicine) Physician22862OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821048851
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE R COSSAART M.D.
Provider Business Mailing Address
First Line : 708 NW 40TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-7046
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 E CLARK BASS BLVD
Second Line :
City : MCALESTER
State : OK
Zip : 74501-4209
Country : US
Telephone Number : 918-426-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 01/13/2021

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Directions to “ MS. NICOLE R COSSAART M.D.” Practice Location

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