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General NPI Number Information
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NPI Number | 1194047167
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Entity Type | Individual
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Provider Name | SHERRY LYNN ROUSE RN
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Gender | Female
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 103 N WHEELER AVE
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City | SALLISAW
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State | OK
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Zip | 74955-4617
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Country | US
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Telephone | 918-775-7751
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Fax | 918-775-7932
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Provider Business Mailing Address
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Address Line | RR 2 BOX 179-1
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City | VIAN
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State | OK
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Zip | 74962-9265
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Country | US
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Telephone | 918-773-8534
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Fax | 918-775-7932
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | R0097115
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | R0097115
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License Number State | OK
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