Healthcare Provider Details

I. General information

NPI: 1790505501
Provider Name (Legal Business Name): SHAWNIE ALLISON RICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8304
US

IV. Provider business mailing address

2700 RICHARDSON DR
NORMAN OK
73071-4126
US

V. Phone/Fax

Practice location:
  • Phone: 405-486-8766
  • Fax:
Mailing address:
  • Phone: 405-845-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number220694
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22942593
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: