Healthcare Provider Details

I. General information

NPI: 1497336861
Provider Name (Legal Business Name): SHELBY M CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 N HWY 81
DUNCAN OK
73533-1416
US

IV. Provider business mailing address

1831 COUNTY STREET 2750
VERDEN OK
73092-8314
US

V. Phone/Fax

Practice location:
  • Phone: 580-606-6201
  • Fax: 580-786-3200
Mailing address:
  • Phone: 405-574-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200708
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: