MEDICARE: DR. NICHOLAS L ZUMWALT RN

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	363LF0000X	Family Nurse Practitioner	204532	OK

General Provider Information

NPI Number	:	1992388284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS L ZUMWALT RN

Provider Business Mailing Address
First Line	:	4105 S CHESTNUT AVE
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74011-1461
Country	:	US
Telephone Number	:	918-760-2853
Fax Number	:

Provider Business Practice Location Address
First Line	:	4623 W KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-8975
Country	:	US
Telephone Number	:	918-461-0422
Fax Number	:

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

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	09/16/2025

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