Individual
SHELLY TENNISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
207 W. MAIN, KANSAS, OK 74347
(918) 868-2567
(918) 868-5584
Mailing address
PO BOX 196, KANSAS, OK 74347-0196
(918) 868-2567
(918) 868-5584
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Enumeration date
10/09/2015
Last updated
10/09/2015
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