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General NPI Number Information
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NPI Number | 1881256691
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Entity Type | Individual
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Provider Name | SHELLY LYNN GREEN APRN
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 1321 W. 7TH STREET
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City | STILLWATER
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State | OK
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Zip | 74074
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Country | US
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Telephone | 405-372-8200
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Fax | 405-743-2619
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Provider Business Mailing Address
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Address Line | 8 N. TAWANA DRIVE
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City | SHAWNEE
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State | OK
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Zip | 74804
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Country | US
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Telephone | 405-205-8855
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Fax | 405-205-8855
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F06192445
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License Number State | OK
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