Provider Demographics
NPI:1376946889
Name:SHIRK, LARA EILEEN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:EILEEN
Last Name:SHIRK
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2494
Mailing Address - Country:US
Mailing Address - Phone:405-378-5491
Mailing Address - Fax:405-378-5492
Practice Address - Street 1:1060 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2494
Practice Address - Country:US
Practice Address - Phone:405-378-5491
Practice Address - Fax:405-378-5492
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily