Provider Demographics
NPI:1740756840
Name:EDIRISOORIYA, DARSHI WICKRAMA (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:DARSHI
Middle Name:WICKRAMA
Last Name:EDIRISOORIYA
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-6207
Mailing Address - Country:US
Mailing Address - Phone:918-283-4660
Mailing Address - Fax:
Practice Address - Street 1:1001 N FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-6207
Practice Address - Country:US
Practice Address - Phone:918-283-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKM131211363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics