Provider Demographics
NPI:1700109824
Name:DIMICK, MELISSA M (CNS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:DIMICK
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 S YALE AVE
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6151 S YALE AVE
Practice Address - Street 2:SUITE A-100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1907
Practice Address - Country:US
Practice Address - Phone:918-494-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55596163WM0705X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical