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NPI Code Detail

MEDICARE: MS. ANGELA RENEE SHORT

MEDICARE: MS. ANGELA RENEE SHORT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)311698OK

General Provider Information

NPI Number : 1811417934
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANGELA RENEE SHORT
Provider Business Mailing Address
First Line : 23110 E 67TH ST S
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74014-2103
Country : US
Telephone Number : 918-630-4663
Fax Number :
Provider Business Practice Location Address
First Line : 2121 S 125TH EAST AVE STE 106
Second Line :
City : TULSA
State : OK
Zip : 74129-5800
Country : US
Telephone Number : 918-574-8442
Fax Number : 918-591-3955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2017
Last Update Date : 02/22/2024

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Directions to “ MS. ANGELA RENEE SHORT ” Practice Location

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