Healthcare Provider Details

I. General information

NPI: 1952235632
Provider Name (Legal Business Name): WILLIAM MACON SHEPHERD III CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4090
US

IV. Provider business mailing address

3819 S ROCKFORD AVE
TULSA OK
74105-3321
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-1000
  • Fax:
Mailing address:
  • Phone: 281-620-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number229190
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: