Provider Demographics
NPI:1003058132
Name:HOWARD, SHERRY LYNN (REGISTERED NURSE/RN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:REGISTERED NURSE/RN
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:LYNN
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE/RN
Mailing Address - Street 1:641 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-3609
Mailing Address - Country:US
Mailing Address - Phone:918-284-2417
Mailing Address - Fax:
Practice Address - Street 1:641 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-3609
Practice Address - Country:US
Practice Address - Phone:918-284-2417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0069071163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK98HH-002-LOtherMEDICARE HOME HEALTH PSYCHIATRIC CARE LOCAL COVERAGE DETERMINATION