Healthcare Provider Details

I. General information

NPI: 1972616183
Provider Name (Legal Business Name): SHARON E HALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 WALNUT DR
ARDMORE OK
73401-2353
US

IV. Provider business mailing address

20 12TH AVE NW
ARDMORE OK
73401-5722
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-0543
  • Fax: 580-226-2284
Mailing address:
  • Phone: 580-223-3411
  • Fax: 580-226-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number506457
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: