Provider Demographics
NPI:1326281106
Name:ELKINS, NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ELKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 12TH AVE NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1227
Mailing Address - Country:US
Mailing Address - Phone:580-226-8646
Mailing Address - Fax:580-226-8641
Practice Address - Street 1:2002 12TH AVE NW
Practice Address - Street 2:SUITE D
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1227
Practice Address - Country:US
Practice Address - Phone:580-226-8646
Practice Address - Fax:580-226-8641
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1788363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant