Individual
SHANNON BOUGHNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 502-1900
Mailing address
6600 S YALE AVE, SUITE 1200, TULSA, OK 74136-3347
(918) 488-6687
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4277
OK
208M00000X
Hospitalist Physician
Primary
4277
OK
Other
Enumeration date
08/27/2007
Last updated
07/31/2017
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