Healthcare Provider Details

I. General information

NPI: 1386947570
Provider Name (Legal Business Name): SHANNON LEE BIERIG APRN-CNP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON LEE BIERIG MS, APN, CCNS

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N 14TH ST
PONCA CITY OK
74601-1734
US

IV. Provider business mailing address

2501 N 14TH ST
PONCA CITY OK
74601-1734
US

V. Phone/Fax

Practice location:
  • Phone: 580-749-5076
  • Fax:
Mailing address:
  • Phone: 580-749-5076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59027
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number59027
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: