Healthcare Provider Details

I. General information

NPI: 1306771068
Provider Name (Legal Business Name): ALTHEA LYNNETTE SHIRLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EUNICE BURNS RD
EUFAULA OK
74432-4052
US

IV. Provider business mailing address

500 EUNICE BURNS RD
EUFAULA OK
74432-4052
US

V. Phone/Fax

Practice location:
  • Phone: 918-689-2547
  • Fax:
Mailing address:
  • Phone: 918-689-2547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number197490
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR0081356
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: