Provider Demographics
NPI:1790719730
Name:RICHARDS, SHARON (APRN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 S ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-6411
Mailing Address - Country:US
Mailing Address - Phone:918-824-8000
Mailing Address - Fax:918-825-5505
Practice Address - Street 1:562 S ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-6411
Practice Address - Country:US
Practice Address - Phone:918-824-8000
Practice Address - Fax:918-825-5505
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0049120363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100145670AMedicaid
S96250Medicare UPIN
OK100145670AMedicaid