Healthcare Provider Details

I. General information

NPI: 1336789197
Provider Name (Legal Business Name): SHELBY WORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 COMMONS CIR STE A
YUKON OK
73099-9522
US

IV. Provider business mailing address

1817 COMMONS CIR STE A
YUKON OK
73099-9522
US

V. Phone/Fax

Practice location:
  • Phone: 405-324-0961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67172
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-109313
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: