=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043682131
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHERRIE G. WILLIAMSON D.O., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2015
-----------------------------------------------------
Last Update Date | 10/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2416 TEE CIR
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-6378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-701-1010
-----------------------------------------------------
Fax | 405-701-1011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2416 TEE CIR
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-6378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-701-1010
-----------------------------------------------------
Fax | 405-701-1011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | NATALIE SCHULTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-701-1010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 1588
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------