Provider Demographics
NPI:1811466998
Name:NIMZ, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:NIMZ
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 1:13313 OUTDOOR LIVING DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-5302
Mailing Address - Country:US
Mailing Address - Phone:405-664-7074
Mailing Address - Fax:
Practice Address - Street 1:13313 OUTDOOR LIVING DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-5302
Practice Address - Country:US
Practice Address - Phone:405-664-7074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-18
Last Update Date:2018-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF10181454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily