Provider Demographics
NPI:1134135411
Name:NILSON, DEBORAH (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:NILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:SPERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:432 S MUSTANG ROAD
Mailing Address - Street 2:STE A
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7312
Mailing Address - Country:US
Mailing Address - Phone:405-467-4399
Mailing Address - Fax:405-467-4487
Practice Address - Street 1:432 S MUSTANG ROAD
Practice Address - Street 2:STE A
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7312
Practice Address - Country:US
Practice Address - Phone:405-467-4399
Practice Address - Fax:405-467-4487
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK43732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200105620AMedicaid
OKOK700952Medicare PIN