Provider Demographics
NPI:1629334701
Name:THOMPSON, NICHOLAS K (DO)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:K
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5310 E 31ST ST STE 13
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5013
Mailing Address - Country:US
Mailing Address - Phone:918-561-5701
Mailing Address - Fax:918-561-1173
Practice Address - Street 1:9645 RIVERSIDE PKWY STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7427
Practice Address - Country:US
Practice Address - Phone:918-209-5170
Practice Address - Fax:918-209-5187
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK5451207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200510850BMedicaid