Healthcare Provider Details

I. General information

NPI: 1720979131
Provider Name (Legal Business Name): SHANNON MICHAEL DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 S SUNNYLANE RD
OKLAHOMA CITY OK
73115-3656
US

IV. Provider business mailing address

3916 S SUNNYLANE RD
OKLAHOMA CITY OK
73115-3656
US

V. Phone/Fax

Practice location:
  • Phone: 405-677-3378
  • Fax:
Mailing address:
  • Phone: 405-677-3378
  • Fax: 405-930-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224646
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: