Healthcare Provider Details

I. General information

NPI: 1316358195
Provider Name (Legal Business Name): ASHTON NICOLE SHELTON DC, CACCP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 S SANGRE RD
STILLWATER OK
74074-1869
US

IV. Provider business mailing address

1505 S SANGRE RD
STILLWATER OK
74074-1869
US

V. Phone/Fax

Practice location:
  • Phone: 405-372-9200
  • Fax:
Mailing address:
  • Phone: 405-612-1592
  • Fax: 405-372-9203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-315242
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4153
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: