Healthcare Provider Details

I. General information

NPI: 1013586445
Provider Name (Legal Business Name): SHEKEYLA YOUNG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 S HIGHWAY 77
NEWKIRK OK
74647-7009
US

IV. Provider business mailing address

212 N MAIN ST
FAIRFAX OK
74637-3023
US

V. Phone/Fax

Practice location:
  • Phone: 580-362-2555
  • Fax: 580-362-2948
Mailing address:
  • Phone: 918-642-3100
  • Fax: 918-642-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4637
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: