MEDICARE: MS. KESHA DEVONNE SHEPHERD B.S.

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1811171069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KESHA DEVONNE SHEPHERD B.S.

Provider Business Mailing Address
First Line	:	5310 E 31ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-5012
Country	:	US
Telephone Number	:	918-712-4301
Fax Number	:

Provider Business Practice Location Address
First Line	:	5310 E 31ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-5012
Country	:	US
Telephone Number	:	918-492-2554
Fax Number	:	918-494-9870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	04/01/2024

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