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General NPI Number Information
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NPI Number | 1093583460
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Entity Type | Individual
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Provider Name | SHANNON DEWAYNE CONLEY
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Gender | Male
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Dates
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Enumeration Date | 12/15/2023
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 700 S PENN AVE
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City | BARTLESVILLE
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State | OK
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Zip | 74003-3847
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Country | US
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Telephone | 918-273-1841
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Fax |
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Provider Business Mailing Address
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Address Line | 607 COUNTY ROAD 3901
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City | PAWHUSKA
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State | OK
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Zip | 74056-5244
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Country | US
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Telephone | 918-327-9253
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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