Individual
MRS. SHANON ELIZABETH PAXSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25322 S 603 RD, GROVE, OK 74344
(918) 787-4368
Mailing address
25322 S 603 RD, GROVE, OK 74344
(918) 787-4368
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
1000670490A
OK
347C00000X
Private Vehicle
Primary
1000670490C
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000670490A
OHCA
OK
01
—
1000670490C
OHCA
OK
Enumeration date
06/27/2007
Last updated
09/11/2025
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