Healthcare Provider Details

I. General information

NPI: 1346660834
Provider Name (Legal Business Name): AMBER LEE SHIPMAN MD, FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12512 E 21ST ST
TULSA OK
74129-1806
US

IV. Provider business mailing address

12512 E 21ST ST
TULSA OK
74129-1806
US

V. Phone/Fax

Practice location:
  • Phone: 918-591-3969
  • Fax: 405-703-0645
Mailing address:
  • Phone: 918-591-3969
  • Fax: 405-703-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30740
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: