Provider Demographics
NPI:1669919858
Name:ROGERS, SHERRY ELIZABETH (CAC)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:ELIZABETH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-1405
Mailing Address - Country:US
Mailing Address - Phone:405-714-8802
Mailing Address - Fax:
Practice Address - Street 1:602 W CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-1405
Practice Address - Country:US
Practice Address - Phone:405-714-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK0305171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist