Provider Demographics
NPI:1568424190
Name:WOODRUFF, LINDA SUE (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:SUE
Other - Last Name:FRICKENSCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-395-2319
Mailing Address - Fax:580-395-2551
Practice Address - Street 1:158 E SUNSET DR
Practice Address - Street 2:SUITE B
Practice Address - City:MEDFORD
Practice Address - State:OK
Practice Address - Zip Code:73759-2401
Practice Address - Country:US
Practice Address - Phone:580-395-2319
Practice Address - Fax:580-395-2551
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0031696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200037530AMedicaid
OKOK402633Medicare PIN
OKQ17374Medicare UPIN
OKP00729849Medicare UPIN