Provider Demographics
NPI:1457638454
Name:RICHARDSON, SHERRY DAVIS
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:DAVIS
Last Name:RICHARDSON
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 1:2545 NW 179TH CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-0669
Mailing Address - Country:US
Mailing Address - Phone:405-606-5123
Mailing Address - Fax:
Practice Address - Street 1:2545 NW 179TH CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012
Practice Address - Country:US
Practice Address - Phone:405-606-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor