Provider Demographics
NPI:1033722145
Name:NICKELS, KAREN GAIL (LPN, LMT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:GAIL
Last Name:NICKELS
Suffix:
Gender:F
Credentials:LPN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29408 S 548 RD
Mailing Address - Street 2:
Mailing Address - City:COOKSON
Mailing Address - State:OK
Mailing Address - Zip Code:74427-2423
Mailing Address - Country:US
Mailing Address - Phone:918-630-2342
Mailing Address - Fax:
Practice Address - Street 1:29408 S 548 RD
Practice Address - Street 2:
Practice Address - City:COOKSON
Practice Address - State:OK
Practice Address - Zip Code:74427-2423
Practice Address - Country:US
Practice Address - Phone:918-630-2342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK70432164W00000X
OK102510225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse