Individual
SHAMEKA MARIE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13515 VINITA DR, OKLAHOMA CITY, OK 73142-9201
(405) 924-2792
Mailing address
13515 VINITA DR, OKLAHOMA CITY, OK 73142-9201
(405) 924-2792
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0101004
OK
163WC0400X
Case Management Registered Nurse
R0101004
OK
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
R0101004
OK
Other
Enumeration date
12/21/2023
Last updated
12/21/2023
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