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NPI Code Detail

MEDICARE: SHANNON KELLY AAPS

MEDICARE: SHANNON KELLY AAPS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1255590311
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON KELLY AAPS
Provider Business Mailing Address
First Line : 650 S PEORIA AVE
Second Line :
City : TULSA
State : OK
Zip : 74120-4429
Country : US
Telephone Number : 918-587-9471
Fax Number : 918-560-1399
Provider Business Practice Location Address
First Line : 1055 S HOUSTON AVE
Second Line :
City : TULSA
State : OK
Zip : 74127-9043
Country : US
Telephone Number : 918-921-3200
Fax Number : 918-560-1399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2008
Last Update Date : 10/21/2015

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Directions to “ SHANNON KELLY AAPS” Practice Location

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