Provider Demographics
NPI:1700310497
Name:MOODY, SHERRY RANEE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:RANEE
Last Name:MOODY
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 SW B AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3954
Mailing Address - Country:US
Mailing Address - Phone:580-248-3900
Mailing Address - Fax:580-248-1987
Practice Address - Street 1:813 SW B AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3954
Practice Address - Country:US
Practice Address - Phone:580-248-3900
Practice Address - Fax:580-248-1987
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK95598163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse