Provider Demographics
NPI:1982696662
Name:RANEY, SUE ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANN
Last Name:RANEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-0725
Mailing Address - Country:US
Mailing Address - Phone:580-225-5900
Mailing Address - Fax:580-225-5901
Practice Address - Street 1:601 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5205
Practice Address - Country:US
Practice Address - Phone:580-225-5900
Practice Address - Fax:580-225-5901
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0026745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS97562Medicare UPIN