Provider Demographics
NPI:1609695493
Name:MOORE, SHARLA DARLENE
Entity type:Individual
Prefix:MS
First Name:SHARLA
Middle Name:DARLENE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26115 COUNTY ROAD 1260
Mailing Address - Street 2:
Mailing Address - City:GRACEMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73042-9408
Mailing Address - Country:US
Mailing Address - Phone:405-933-5474
Mailing Address - Fax:
Practice Address - Street 1:26115 COUNTY ROAD 1260
Practice Address - Street 2:
Practice Address - City:GRACEMONT
Practice Address - State:OK
Practice Address - Zip Code:73042-9408
Practice Address - Country:US
Practice Address - Phone:405-933-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNONE172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker