Provider Demographics
NPI:1598219453
Name:EMMONS, SHARON (MED)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:EMMONS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102420 S HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-6803
Mailing Address - Country:US
Mailing Address - Phone:405-550-5620
Mailing Address - Fax:918-968-9230
Practice Address - Street 1:102420 S HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864-6803
Practice Address - Country:US
Practice Address - Phone:405-550-5620
Practice Address - Fax:918-968-9230
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health