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General NPI Number Information
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NPI Number | 1093610339
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Entity Type | Organization
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Legal Business Name | SHANNON BRUEY PMHMP LLC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 1750 W LAKEVIEW RD
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City | STILLWATER
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State | OK
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Zip | 74075-2746
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Country | US
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Telephone | 405-984-4802
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Fax | 405-984-4819
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Provider Business Mailing Address
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Address Line | 1750 W LAKEVIEW RD
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City | STILLWATER
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State | OK
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Zip | 74075-2746
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Country | US
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Telephone | 405-984-4802
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Fax | 405-984-4819
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | SHANNON BRUEY
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Credential | PMHNP-BC, APRN-CNP
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Telephone | 405-984-4802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State | NULL
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