Provider Demographics
NPI:1720189350
Name:WOMACK, DAWN CERISE (ARNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:CERISE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 W.MEMORIAL RD
Mailing Address - Street 2:901
Mailing Address - City:OKLAHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8305
Mailing Address - Country:US
Mailing Address - Phone:405-749-4247
Mailing Address - Fax:405-749-4249
Practice Address - Street 1:4200 W MEMORIAL RD
Practice Address - Street 2:901
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9350
Practice Address - Country:US
Practice Address - Phone:405-749-4247
Practice Address - Fax:405-749-4249
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0062718363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100214830AMedicaid
OK$$$$$$$$$Medicare PIN
OKP33750Medicare UPIN