Provider Demographics
NPI:1336499953
Name:WHITNEY, SHARON KAY
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:KAY
Other - Last Name:KETTERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6818
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73153-0818
Mailing Address - Country:US
Mailing Address - Phone:405-613-1031
Mailing Address - Fax:
Practice Address - Street 1:12101 N MACARTHUR BLVD # A-178
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1800
Practice Address - Country:US
Practice Address - Phone:405-613-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional