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NPI Code Detail

MEDICARE: JESURUN SHELTON

MEDICARE: JESURUN SHELTON
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1184589269
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESURUN SHELTON
Provider Business Mailing Address
First Line : 1719 W CAMERON ST
Second Line :
City : TULSA
State : OK
Zip : 74127-6708
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2448 E 81ST ST STE 4460
Second Line :
City : TULSA
State : OK
Zip : 74137-4251
Country : US
Telephone Number : 918-600-2966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2025
Last Update Date : 12/19/2025

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Directions to “ JESURUN SHELTON ” Practice Location

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