Individual
MRS. SHANNON REAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP FNP-C
Contact information
Practice address
21625 E 460 RD, CLAREMORE, OK 74019-2876
(918) 606-5702
Mailing address
35904 S HIGHWAY 82, VINITA, OK 74301-6743
(918) 782-1414
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F04190051
OK
Other
Enumeration date
01/07/2020
Last updated
01/07/2020
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