Healthcare Provider Details

I. General information

NPI: 1083169403
Provider Name (Legal Business Name): SHELLY SCHOONOVER APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 S YORK ST
MUSKOGEE OK
74403-7650
US

IV. Provider business mailing address

PO BOX 751
HULBERT OK
74441-0751
US

V. Phone/Fax

Practice location:
  • Phone: 918-683-0470
  • Fax:
Mailing address:
  • Phone: 918-772-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number68346
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: