Healthcare Provider Details

I. General information

NPI: 1336641786
Provider Name (Legal Business Name): MRS. SHERRI GEANETTE HILBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N. BROADWAY
CARNEGIE OK
73015
US

IV. Provider business mailing address

225 N. BROADWAY P.O. BOX 99
CARNEGIE OK
73015
US

V. Phone/Fax

Practice location:
  • Phone: 580-654-1439
  • Fax: 580-654-2637
Mailing address:
  • Phone: 580-654-1439
  • Fax: 580-654-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1196
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: