Individual
KALLIE LENN SHAFFETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
103 W MAIN ST, WILBURTON, OK 74578-4043
(918) 465-7890
Mailing address
3747 NE 1049TH AVE, RED OAK, OK 74563-5143
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
13289
OK
Other
Enumeration date
03/03/2026
Last updated
03/03/2026
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