Provider Demographics
NPI:1043466014
Name:MITCHELL, SHERRY DIANN (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:DIANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5862
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-5862
Mailing Address - Country:US
Mailing Address - Phone:405-356-3035
Mailing Address - Fax:405-356-3031
Practice Address - Street 1:309 W. 2ND ST.
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OK
Practice Address - Zip Code:74881
Practice Address - Country:US
Practice Address - Phone:405-356-2998
Practice Address - Fax:405-356-9937
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0080778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100492420BMedicaid
OKOK401437Medicare PIN