Individual
SHAKOTA LACY CHEYENNE NEAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 N UNIVERSITY DR, EDMOND, OK 73034-5207
(405) 514-1215
Mailing address
100 N UNIVERSITY DR, EDMOND, OK 73034-5207
(405) 514-1215
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568870970
—
OK
Enumeration date
07/11/2022
Last updated
07/11/2022
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