| Doctor Name: | JEARLYN KAY NICK |
| NPI Number: | 1033222401 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | ROO46187 |
| Business Practice Address: | 1151 S Belmont Ave Suite 101 Okmulgee, OK - 744476307 |
| Business Phone Number: | 9187592200 |
| Business Fax Number: | 9187592206 |
| Mailing Address: | 1805 Sleepy Hollow Rd, OKMULGEE |
| State: | OK |
| Postal Code: | 744477112 |
| Phone Number: | 9187592200 |
| Fax Number: | 9187592206 |
| NPI Enumeration Date: | 08/17/2006 |
| NPI Last Update Date: | 07/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ROO46187 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |