Provider Demographics
NPI:1053611103
Name:BURSON, SHERI CANDIDA (APRN-CNP)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:CANDIDA
Last Name:BURSON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:
Other - Last Name:LEVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1145 S UTICA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4013
Mailing Address - Country:US
Mailing Address - Phone:918-579-3825
Mailing Address - Fax:918-579-1262
Practice Address - Street 1:2946 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-631-3717
Practice Address - Fax:918-631-2078
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78881363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1053611103Medicaid