Provider Demographics
NPI:1164982104
Name:MOSS, SHEILA DIANE (FNP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:DIANE
Last Name:MOSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11326 NW 121ST PL
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8141
Mailing Address - Country:US
Mailing Address - Phone:405-202-6913
Mailing Address - Fax:
Practice Address - Street 1:11100 HEFNER POINTE DR STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5049
Practice Address - Country:US
Practice Address - Phone:405-839-7340
Practice Address - Fax:405-839-7341
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily