Provider Demographics
NPI:1447238514
Name:BATEMAN, NICHOLE (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:BATEMAN
Other - Last Name:SATTERWHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C, MPAS
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:918-540-7867
Mailing Address - Fax:918-540-7875
Practice Address - Street 1:310 2ND AVE SW STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6708
Practice Address - Country:US
Practice Address - Phone:918-540-7867
Practice Address - Fax:918-540-7875
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA851363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100188810AMedicaid
OK447687887004OtherBLUE CROSS BLUE SHIELD
OK800522091Medicare ID - Type UnspecifiedGROUP #
OK100188810AMedicaid