Basic Information
| Provider Information | |||||||||
| NPI: | 1134636616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORTH | ||||||||
| FirstName: | SHERRI | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 404 S 10TH ST | ||||||||
| Address2: | |||||||||
| City: | KINGFISHER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737503015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052011920 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 107 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | KINGFISHER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737502730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053753735 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2018 | ||||||||
| LastUpdateDate: | 01/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 50429 | OK | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.