MEDICARE: NICOLE DECAMP 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
1	207N00000X	Dermatology Physician	19832	OK

General Provider Information

NPI Number	:	1942246475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DECAMP M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2382
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73101-2382
Country	:	US
Telephone Number	:	405-848-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 N SANTA FE AVE
Second Line	:	SUITE 2015
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7538
Country	:	US
Telephone Number	:	405-848-2800
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	11/28/2016

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