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NPI Code Detail

MEDICARE: SHANNON L KANEASTER MD

MEDICARE: SHANNON L KANEASTER MD
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 Physician23050OK

General Provider Information

NPI Number : 1932177243
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON L KANEASTER MD
Provider Business Mailing Address
First Line : 6800 NW 39TH EXPY
Second Line :
City : BETHANY
State : OK
Zip : 73008-2513
Country : US
Telephone Number : 405-789-6711
Fax Number : 405-349-5145
Provider Business Practice Location Address
First Line : 6800 NW 39TH EXPY
Second Line :
City : BETHANY
State : OK
Zip : 73008-2513
Country : US
Telephone Number : 405-789-6711
Fax Number : 405-349-5145
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2006
Last Update Date : 03/03/2025

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Directions to “ SHANNON L KANEASTER MD” Practice Location

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