Healthcare Provider Details

I. General information

NPI: 1790467942
Provider Name (Legal Business Name): SHARI PETTIT APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 S ELM PL STE J-K
BROKEN ARROW OK
74012-7949
US

IV. Provider business mailing address

PO BOX 140178
BROKEN ARROW OK
74014-0002
US

V. Phone/Fax

Practice location:
  • Phone: 918-882-0444
  • Fax: 918-882-0555
Mailing address:
  • Phone: 918-882-0444
  • Fax: 918-882-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number214475
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: