Provider Demographics
NPI:1053608588
Name:OURS, NICOLE R (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:OURS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:WV
Mailing Address - Zip Code:26801-0097
Mailing Address - Country:US
Mailing Address - Phone:803-435-5270
Mailing Address - Fax:304-897-5915
Practice Address - Street 1:422 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1238
Practice Address - Country:US
Practice Address - Phone:304-538-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2732207Q00000X
SC36745208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC36745OtherLICENSE
WV2732OtherLICENSE