Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicole Coburn

Individual provider Physician Assistant · NPI 1558903369

Nicole Coburn is a Physician Assistant in Tulsa, Oklahoma. Qualified in 2019, 7 years ago. Practices with St John Physicians, Inc, a 264-clinician group and accepts Medicare assignment. Licensed in Oklahoma.

Years since qualifying
7
Licensed in
OK
In the registry since
2019
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Practice location Address checks out

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone: (918) 748-7591
Fax: (918) 403-6352
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 3176 (OK)

Record details

NPI number1558903369
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedOctober 14, 2019
Last updated in NPPESApril 3, 2020
Certification dateApril 3, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice St. John Physicians, Inc. — 264 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Tulsa