Healthcare Provider Details

I. General information

NPI: 1326304643
Provider Name (Legal Business Name): ASHLEY SHELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E 13TH ST SUITE 205
GROVE OK
74344-2975
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE SUITE 280
OKLAHOMA CITY OK
73112-5556
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-2720
  • Fax: 918-786-8020
Mailing address:
  • Phone: 918-786-2720
  • Fax: 918-786-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5925
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: