Healthcare Provider Details

I. General information

NPI: 1083969240
Provider Name (Legal Business Name): LATINA D SHELLEY APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 SW 89TH ST
OKLAHOMA CITY OK
73159-6332
US

IV. Provider business mailing address

PO BOX 891625
OKLAHOMA CITY OK
73189-1625
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-7818
  • Fax: 405-703-0645
Mailing address:
  • Phone: 405-237-3770
  • Fax: 405-703-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR0106308
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: