Healthcare Provider Details

I. General information

NPI: 1942089867
Provider Name (Legal Business Name): SHELBY LAXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HOPPE BLVD
ADA OK
74820-2318
US

IV. Provider business mailing address

9430 COUNTY ROAD 1490
ADA OK
74820-0580
US

V. Phone/Fax

Practice location:
  • Phone: 580-235-0274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: