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General NPI Number Information
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NPI Number | 1508292210
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Entity Type | Organization
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Legal Business Name | SHANNON G. DAVIS, APRN-CNP FAMILY, P.L.L.C
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 3414 NW 135TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-4009
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Country | US
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Telephone | 405-414-1441
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Fax |
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Provider Business Mailing Address
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Address Line | 3414 NW 135TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-4009
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Country | US
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Telephone | 405-749-0900
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Fax | 405-749-0913
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | SHANNON GALE DAVIS
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Credential | APRN-CNP
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Telephone | 405-414-1441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | R69234
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License Number State | OK
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