Healthcare Provider Details

I. General information

NPI: 1417877572
Provider Name (Legal Business Name): SHAREE RESHAWN GOODNO APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAREE RESHAWN HALL

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 FAIRVIEW AVE
PONCA CITY OK
74601-1929
US

IV. Provider business mailing address

208 N STEPHENS ST
PONCA CITY OK
74601-3535
US

V. Phone/Fax

Practice location:
  • Phone: 580-762-9355
  • Fax:
Mailing address:
  • Phone: 580-762-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number230446
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: