KELSEY RENAE NICKLAS (NPI# 1043733769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043733769 |
| Entity Type | Individual |
| Full Name | KELSEY RENAE NICKLAS |
| Practice Address |
9310 N 163rd East Ave Owasso OK 74055 |
| Mailing Address |
9310 N 163rd East Ave Owasso OK 74055-8321 |
| Practice Telephone | (918) 399-5453 |
| Mailing Telephone | 9183995453 |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2017-07-25 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
9310 N 163RD EAST AVE |
| City | OWASSO |
| State | OK |
| Zip Code | 74055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972151587 | Lakecrest Dental-owasso 96th | Dentist | 9551 N. Owasso Expressway, Suite #100, Owasso, OK 74055 | 2019-08-27 |
| 1205328697 | Eddie Duane Gaut | Case Manager/Care Coordinator | 110 W 3rd St., Apt 11, Owasso, OK 74055 | 2018-06-01 |
| 1821586694 | Kaitlyn Konarik | Speech-Language Pathologist | 12899 E 76th St N, Ste. 109, Owasso, OH 74055 | 2018-04-27 |
| 1700259256 | Genscripts Owasso, LLC | Pharmacy | 9538 N Garnett Rd, Suite 102, Owasso, OK 74055 | 2015-11-05 |
| 1770968810 | Premier Anesthesia Management Inc | Clinic/Center | 19236 E Twin Creeks Dr, Owasso, OK 74055 | 2015-07-29 |
| 1598152407 | Justin Lum | Physical Therapist | 12326 E 86th St N, Owasso, OK 74055 | 2015-04-17 |
| 1033507660 | Kimberly Louise Howard | Physical Therapy Assistant | 12899 East 76th St North, Owasso, OK 74055 | 2015-01-06 |
| 1780920629 | Timothy Ryan Thornton | Behavioral Analyst | 11330 N 94 E Ave, Owasso, OK 74055 | 2012-12-21 |
| 1679842785 | Kelli Marie Ellis | Counselor | 19760 E Fox Run Cir, Owasso, OK 74055 | 2011-12-19 |
| 1659689248 | Custom Dental of Owasso, Pllc | Dentist | 11501 N. 135th East Ave, Owasso, OK 74055 | 2010-09-17 |
| Find all providers in zip 74055 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285259739 | Courtney Mariah Taylor | Case Manager/Care Coordinator | 15104 E 109th St N, Owasso, OK 74055-6049 | 2020-06-10 |
| 1578115184 | Catherine J Sexton-schmitt | Case Manager/Care Coordinator | 8806 N 119th East Ave, Owasso, OK 74055-2080 | 2019-07-13 |
| 1700448883 | Kelly Hallquist | Case Manager/Care Coordinator | 15003 E 89th Pl N, Owasso, OK 74055-4883 | 2019-06-28 |
| 1316407315 | Mariah Dalee Blunt I | Case Manager/Care Coordinator | 10604 E 96th Pl N, Owasso, OK 74055-4343 | 2019-03-25 |
| 1801365929 | Marty Drake Colvin | Case Manager/Care Coordinator | 8915 N 119th East Ave, Owasso, OK 74055-2083 | 2018-11-19 |
| 1457831695 | Joshua Michael Gagner | Case Manager/Care Coordinator | 14617 E 104th St N, Owasso, OK 74055-4820 | 2018-08-17 |
| 1205328697 | Eddie Duane Gaut | Case Manager/Care Coordinator | 110 W 3rd St., Apt 11, Owasso, OK 74055 | 2018-06-01 |
| 1902305139 | Stephanie Lee Anderson | Case Manager/Care Coordinator | 15599 E 78th St N, Owasso, OK 74055-6036 | 2018-02-02 |
| 1588173710 | Jason Drake | Case Manager/Care Coordinator | 11101 N 119th East Ave, Owasso, OK 74055-3709 | 2017-09-20 |
| 1487173647 | Tucker B Carter | Case Manager/Care Coordinator | 8906 N 123rd East Ave, Owasso, OK 74055-2063 | 2017-09-19 |
| Find all providers in OWASSO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.