Healthcare Provider Details

I. General information

NPI: 1154030724
Provider Name (Legal Business Name): LTCNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14355 W CRESCENT DOVER RD
CRESCENT OK
73028
US

IV. Provider business mailing address

14355 W CRESCENT DOVER RD
CRESCENT OK
73028-3311
US

V. Phone/Fax

Practice location:
  • Phone: 405-650-5561
  • Fax: 405-400-2559
Mailing address:
  • Phone:
  • Fax: 405-400-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANNON DUNN
Title or Position: OWNER
Credential: DNP
Phone: 405-560-5561