NICOLE MARIE CANNON (NPI# 1124313788) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124313788 |
| Entity Type | Individual |
| Full Name | NICOLE MARIE CANNON |
| Practice Address |
6333 E Skelly Dr Tulsa OK 74135-6106 |
| Mailing Address |
1008 N Roosevelt Ave Sand Springs OK 74063-7355 |
| Practice Telephone | 9186644224 |
| Mailing Telephone | 3188053830 |
| Enumeration Date | 2011-06-12 |
| Last Update Date | 2011-06-12 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376041632 | Nicole Cannon | Occupational Therapist | 19411 Mckay Dr Ste 300, Humble, TX 77338-5713 | 2018-01-31 |
| 1942451356 | Nicole Margaret Cannon | Physical Therapist | 2129 W Oregon Ave, Philadelphia, PA 19145-4131 | 2008-10-03 |
| 1356559702 | Nicole A Cannon | Student in an Organized Health Care Education/Training Program | 1333 Willow Pass Rd, 102, Concord, CA 94520-7930 | 2007-05-18 |
| Street Address |
6333 E SKELLY DR |
| City | TULSA |
| State | OK |
| Zip Code | 74135-6106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053317883 | 12 & 12, Inc. | Substance Abuse Rehabilitation Facility | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2005-06-27 |
| 1720685175 | Jesse Misthaven | Registered Nurse | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-10-07 |
| 1699372482 | Christine Reynold | Registered Nurse | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-10-05 |
| 1679185920 | Kacey Ann Cottrell | Registered Nurse | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-08-18 |
| 1861003931 | Matthew Schane | Case Manager/Care Coordinator | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-08-12 |
| 1841817368 | Bernadette Bouciquot | Registered Nurse | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-06-30 |
| 1568088011 | Brenda Kay Kuntzelman | Licensed Practical Nurse | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-06-21 |
| 1023634698 | Kelli Ann Ordorica | Case Manager/Care Coordinator | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-06-19 |
| 1215552120 | Amanda Lindsey Spicer | Case Manager/Care Coordinator | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-06-16 |
| 1619592672 | Tieraney Candice Rodriguez | Case Manager/Care Coordinator | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-06-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437761590 | Dr. Whitney M. Ellsworth, Dpt, Pllc | Physical Therapist | 4185 S Harvard Ave, Suite E-1, Tulsa, OK 74135 | 2020-08-20 |
| 1942839089 | Kimberly Renee Gillens | Student in an Organized Health Care Education/Training Program | 4502 E 41st Street Obgyn Department, Tulsa, OK 74135 | 2020-04-01 |
| 1528525524 | Everest Pain Management | Clinic/Center | 4134 S Harvard Ave Suite B1, Tulsa, OK 74135 | 2019-02-26 |
| 1326524216 | Shelley Deeann Anderson | Technician | 7359 S 68th, Tulsa, OK 74135 | 2018-07-14 |
| 1811489065 | Taylor Diane Spears | Behavioral Analyst | 4835 S Fulton Ave Suite 104, Tulsa, OK 74135 | 2018-06-04 |
| 1225547821 | Heather Nicole Freed | Counselor | 4363 S Harvard Ave, Tulsa, OK 74135 | 2017-09-26 |
| 1306363924 | Danielle Walker | Case Manager/Care Coordinator | 3244 S Lakewood Ave Apt 4e, Tulsa, OK 74135 | 2017-08-24 |
| 1346766078 | Angels Place | Day Training, Developmentally Disabled Services | 3919 S. Oswego Avenue, Tulsa, OK 74135 | 2017-08-15 |
| 1659800019 | Welena-phay Kamamma Boren | Counselor | 4636 S Harvard Avenue, Tulsa, OK 74135 | 2017-06-08 |
| 1346774197 | Brandie Herren | Registered Nurse | 6333 E Skelly Drive, Tulsa, OK 74135 | 2017-04-19 |
| Find all providers in zip 74135 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902359391 | Ryan Fitzpatrick | Substance Abuse Rehabilitation Facility | 7138 S Canton Ave, Tulsa, OK 74136-6303 | 2016-08-02 |
| 1184089328 | Door 2 Ur Future | Substance Abuse Rehabilitation Facility | 1050 E 61st St Apt 89, Tulsa, OK 74136-1397 | 2015-12-15 |
| 1104256684 | Robert Watson | Substance Abuse Rehabilitation Facility | 111 W 5th St Ste 600, Tulsa, OK 74103-4260 | 2013-11-19 |
| 1114279718 | Family and Children Services | Substance Abuse Rehabilitation Facility | 10922 E 39th St, Tulsa, OK 74146-2703 | 2012-10-05 |
| 1568683530 | Suzannah Louise Le Brocq | Substance Abuse Rehabilitation Facility | 12&12 Inc., 6333 East Skelly Drive, Tulsa, OK 74135 | 2007-05-01 |
| 1053317883 | 12 & 12, Inc. | Substance Abuse Rehabilitation Facility | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2005-06-27 |
| 1134570252 | Shannon Nolan | Substance Abuse Rehabilitation Facility | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2016-06-30 |
| 1285011858 | John T Bennett | Substance Abuse Rehabilitation Facility | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2015-05-02 |
| 1831527613 | Wanda Mcinturff | Substance Abuse Rehabilitation Facility | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2013-10-14 |
| 1790030872 | Lisa Avery | Substance Abuse Rehabilitation Facility | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2012-07-16 |
| Find all providers in TULSA | ||||
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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.