Provider Demographics
NPI:1265274682
Name:SMITH, NICOLE TAYLOR (AUD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TAYLOR
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:TAYLOR
Other - Last Name:LUEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3954 N KICKAPOO AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1698
Mailing Address - Country:US
Mailing Address - Phone:405-273-6203
Mailing Address - Fax:
Practice Address - Street 1:3954 N KICKAPOO AVE STE 5
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1698
Practice Address - Country:US
Practice Address - Phone:405-273-6203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6237231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist