Provider Demographics
NPI:1366567109
Name:GROSS, SHERYL A (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:A
Last Name:GROSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SHERYL
Other - Middle Name:A
Other - Last Name:LUCIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3500 S. WESTERN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-2413
Mailing Address - Country:US
Mailing Address - Phone:405-632-5565
Mailing Address - Fax:405-632-3538
Practice Address - Street 1:3500 S. WESTERN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-2413
Practice Address - Country:US
Practice Address - Phone:405-632-5565
Practice Address - Fax:405-632-3538
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02795363A00000X
OKPA4416363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA02795OtherLICENSE