Northern Oklahoma Dermatology

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

NORTHERN OKLAHOMA DERMATOLOGY

Practice address

309 SE Frank Phillips Blvd
Bartlesville, OK 74003-3643

Phone

(918) 214-8888

Fax

(918) 214-8887

NPI assigned

Aug 28, 2023

Last updated

May 8, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicholas Albert Mietus, PANPI 1306352422

Title

President/ Owner

Phone

(405) 205-7072

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicholas A Mietus, PA-C

  • Physician Assistant
  • Bartlesville, OK
  • NPI 1306352422
  Medicare reassignment Care Compare group Authorized official
• Sharron Denise Blaylock, M.D.

  • Internal Medicine Physician
  • Bartlesville, OK
  • NPI 1588628978
  Medicare reassignment Care Compare group NPD
• Faith Dinkins

  • Physician Assistant
  • Bartlesville, OK
  • NPI 1477281723
  Medicare reassignment Care Compare group
• Kelsey Joy Glazier, PA

  • Physician Assistant
  • Sapulpa, OK
  • NPI 1336789718
  Medicare reassignment Care Compare group
• Alexandrea D Rigel, PA-C

  • Physician Assistant
  • Bartlesville, OK
  • NPI 1841965340
  Medicare reassignment Care Compare group
• Monica Abbott, PA-C

  • Medical Physician Assistant
  • Tulsa, OK
  • NPI 1598975559
  Medicare reassignment
• Raymond L Cornelison, MD

  • Dermatology Physician
  • Chickasha, OK
  • NPI 1003884339
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1326823485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 SE FRANK PHILLIPS BLVD",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740033643",
            "telephone_number": "918-214-8888",
            "fax_number": "918-214-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 SE FRANK PHILLIPS BLVD",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740033643",
            "telephone_number": "918-214-8888",
            "fax_number": "918-214-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN OKLAHOMA DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-28",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "MIETUS",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "PRESIDENT/ OWNER",
        "authorized_official_telephone_number": "405-205-7072",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Janean Nixon
• Andrew Max Noble, D.D.S.
• Khyrstee Daven Norman
• Northeast Oklahoma Radiology Physicians LLC
• Northeastern Oklahoma Advanced Neurotherapeutics LLC
• NR Bartlesville LLC (Nerve Renewal Bartlesville)
• Ntcob LLC
• Nujoint LLC (Nujoint)
• Tracey Nunez, DPH
• Samantha K Nunn

• Dermatology Physician in Bartlesville, OK
• Providers in Bartlesville, OK by specialty
• Dermatology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.