Provider Demographics
NPI:1376318154
Name:WHIDBY, NICHELLE
Entity type:Individual
Prefix:
First Name:NICHELLE
Middle Name:
Last Name:WHIDBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 E DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:OK
Mailing Address - Zip Code:74085-4012
Mailing Address - Country:US
Mailing Address - Phone:318-801-4915
Mailing Address - Fax:
Practice Address - Street 1:1055 S HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9043
Practice Address - Country:US
Practice Address - Phone:918-921-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist