Healthcare Provider Details

I. General information

NPI: 1568920213
Provider Name (Legal Business Name): SHANNON MARIE SPAULDING APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 WASHINGTON DR STE 100
NORMAN OK
73069-1016
US

IV. Provider business mailing address

1008 24TH AVE NW
NORMAN OK
73069-6369
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-3735
  • Fax:
Mailing address:
  • Phone: 405-310-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number114005
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: