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NPI Code Detail

MEDICARE: LATINA D SHELLEY APRN, CPNP-PC

MEDICARE: LATINA D SHELLEY APRN, CPNP-PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianR0106308OK

General Provider Information

NPI Number : 1083969240
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATINA D SHELLEY APRN, CPNP-PC
Provider Business Mailing Address
First Line : PO BOX 891625
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73189-1625
Country : US
Telephone Number : 405-237-3770
Fax Number : 405-703-0645
Provider Business Practice Location Address
First Line : 2921 SW 89TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-6332
Country : US
Telephone Number : 405-757-7818
Fax Number : 405-703-0645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2012
Last Update Date : 02/05/2026

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