Provider Demographics
NPI:1275317448
Name:ASEPERMY, NICOLE RENAE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENAE
Last Name:ASEPERMY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SE LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-2409
Mailing Address - Country:US
Mailing Address - Phone:580-350-6996
Mailing Address - Fax:
Practice Address - Street 1:2 SE LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-2409
Practice Address - Country:US
Practice Address - Phone:580-350-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist