Healthcare Provider Details

I. General information

NPI: 1689334120
Provider Name (Legal Business Name): SHANNON R BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2021
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E AVENUE C
HEAVENER OK
74937-2603
US

IV. Provider business mailing address

27675 PINE CREST WAY
CAMERON OK
74932-2428
US

V. Phone/Fax

Practice location:
  • Phone: 918-658-4016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number316000
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCCANDIDATE12926
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: