Provider Demographics
NPI:1841267440
Name:SHEWMAKE, RITA JANE (ARNP)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:JANE
Last Name:SHEWMAKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:918-540-7573
Mailing Address - Fax:918-540-7590
Practice Address - Street 1:200 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6830
Practice Address - Country:US
Practice Address - Phone:918-540-7573
Practice Address - Fax:918-540-7590
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200468380YMedicaid
OK100229140AMedicaid
800522468Medicare PIN
OKS90280Medicare UPIN
OK100229140AMedicaid
OK299463YKW9Medicare PIN
DD8311Medicare PIN
800522468Medicare PIN
P00747093Medicare PIN