Provider Demographics
NPI:1548389000
Name:STANDAGE, SHERYL A (NP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:A
Last Name:STANDAGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:A
Other - Last Name:KINCAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:800 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5418
Mailing Address - Country:US
Mailing Address - Phone:405-271-8778
Mailing Address - Fax:
Practice Address - Street 1:800 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5418
Practice Address - Country:US
Practice Address - Phone:405-271-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0029568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner