Provider Demographics
NPI:1518561216
Name:GATER, NICOLE AMERALD
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:AMERALD
Last Name:GATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:AMERALD
Other - Last Name:PENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13257 S 93RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-3585
Mailing Address - Country:US
Mailing Address - Phone:918-932-0230
Mailing Address - Fax:
Practice Address - Street 1:13257 S 93RD EAST AVE
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-3585
Practice Address - Country:US
Practice Address - Phone:918-932-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator