Healthcare Provider Details

I. General information

NPI: 1235848417
Provider Name (Legal Business Name): SHELBY NICOLE BETSEY RT(R), CHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S EIGHT TRIBES TRL
MIAMI OK
74354-1002
US

IV. Provider business mailing address

118 S EIGHT TRIBES TRL
MIAMI OK
74354-1002
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-2535
  • Fax:
Mailing address:
  • Phone: 918-540-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number22-05459
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: