Healthcare Provider Details

I. General information

NPI: 1386377000
Provider Name (Legal Business Name): SHELLEY LARAE RAUH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2022
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MAIN ST
HENNESSEY OK
73742-1019
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 405-853-6100
  • Fax: 405-853-4491
Mailing address:
  • Phone: 405-853-6100
  • Fax: 405-853-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209030
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: