Individual
SHELLYE SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
350 S 40TH ST, MUSKOGEE, OK 74401-4915
(918) 683-0753
(918) 683-5677
Mailing address
350 S 40TH ST, MUSKOGEE, OK 74401-4915
(918) 683-0753
(918) 683-5677
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
R0075190
OK
363LF0000X
Family Nurse Practitioner
Primary
75190
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200746490A
—
OK
Enumeration date
11/09/2017
Last updated
01/10/2018
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