Healthcare Provider Details

I. General information

NPI: 1942806914
Provider Name (Legal Business Name): JENNIFER SHELTON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S CULVER ST
MEEKER OK
74855-9008
US

IV. Provider business mailing address

1018 24TH AVE NW STE 110
NORMAN OK
73069-6556
US

V. Phone/Fax

Practice location:
  • Phone: 209-324-3863
  • Fax:
Mailing address:
  • Phone: 405-466-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-537814
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: