Healthcare Provider Details

I. General information

NPI: 1184675464
Provider Name (Legal Business Name): SHERYL EVONE GHAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 J T STITES BLVD
SALLISAW OK
74955-9302
US

IV. Provider business mailing address

5831 EUPER LN
FORT SMITH AR
72903-3239
US

V. Phone/Fax

Practice location:
  • Phone: 918-775-9150
  • Fax:
Mailing address:
  • Phone: 479-629-6125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE0744
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3197
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: