# NR SHAWNEE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NERVE RENEWAL SHAWNEE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922861004
- **Authorized official:** TIMOTHY COIT BALES (CEO)
- **Authorized official phone:** (405) 953-7221

## Contact information

- **Practice address:** 3700 N KICKAPOO AVE STE 116, SHAWNEE, OK 74804-0007
- **Practice address phone:** (405) 551-8103
- **Practice address fax:** (405) 669-3517
- **Mailing address:** 3705 NW 63RD ST STE 200, OKLAHOMA CITY, OK 73116-1937
- **Mailing address phone:** (405) 953-7221
- **Mailing address fax:** (405) 669-3517

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/01/2024
- **Last updated:** 03/03/2025