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
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone: (918) 748-7591
Fax: (918) 403-6352
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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
Mailing address1923 S Utica Ave, Tulsa, OK 74104-6520

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