Provider Demographics
NPI:1336641786
Name:HILBURN, SHERRI GEANETTE
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:GEANETTE
Last Name:HILBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N. BROADWAY
Mailing Address - Street 2:P.O. BOX 99
Mailing Address - City:CARNEGIE
Mailing Address - State:OK
Mailing Address - Zip Code:73015
Mailing Address - Country:US
Mailing Address - Phone:580-654-1439
Mailing Address - Fax:580-654-2637
Practice Address - Street 1:225 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:OK
Practice Address - Zip Code:73015
Practice Address - Country:US
Practice Address - Phone:580-654-1439
Practice Address - Fax:580-654-2637
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1196313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100774120AMedicaid