Provider Demographics
NPI:1326561762
Name:DORRIS, NICHOLAS (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:DORRIS
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 HEALTH CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6492
Mailing Address - Country:US
Mailing Address - Phone:405-806-2204
Mailing Address - Fax:405-806-2207
Practice Address - Street 1:1491 HEALTH CENTER PKWY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6492
Practice Address - Country:US
Practice Address - Phone:405-806-2200
Practice Address - Fax:405-806-2207
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK98110363LF0000X
OKR0098110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily