Provider Demographics
NPI:1477839728
Name:WILKINS, NICOLE ANNE (EDD, ATC, LAT)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANNE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:EDD, ATC, LAT
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ANNE
Other - Last Name:REIMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC, LAT
Mailing Address - Street 1:3001 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6425
Mailing Address - Country:US
Mailing Address - Phone:512-416-5802
Mailing Address - Fax:866-456-6076
Practice Address - Street 1:800 S TUCKER DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-9700
Practice Address - Country:US
Practice Address - Phone:918-631-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT43582255A2300X
OKAT11482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer