Provider Demographics
NPI:1194047167
Name:ROUSE, SHERRY LYNN (RN)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:ROUSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 179-1
Mailing Address - Street 2:
Mailing Address - City:VIAN
Mailing Address - State:OK
Mailing Address - Zip Code:74962-9265
Mailing Address - Country:US
Mailing Address - Phone:918-773-8534
Mailing Address - Fax:918-775-7932
Practice Address - Street 1:103 N WHEELER AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4617
Practice Address - Country:US
Practice Address - Phone:918-775-7751
Practice Address - Fax:918-775-7932
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0097115163WA2000X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator