Healthcare Provider Details

I. General information

NPI: 1093647703
Provider Name (Legal Business Name): SHERRY ANN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11332 NS 3500 RD
SHAWNEE OK
74804-1554
US

IV. Provider business mailing address

11332 NS 3500 RD
SHAWNEE OK
74804-1554
US

V. Phone/Fax

Practice location:
  • Phone: 405-380-8011
  • Fax:
Mailing address:
  • Phone: 405-380-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL0050406
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: