Individual
SHIRLEY CHESNUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
10 S. TREATY, MIAMI, OK 74354-5330
(918) 542-6644
(918) 542-6167
Mailing address
10 S. TREATY, MIAMI, OK 74354-5330
(918) 542-6644
(918) 542-6167
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2107
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100111160A
—
OK
01
—
74344A010
CHAMPUS
OK
01
—
74354A003
CHAMPUS
OK
Enumeration date
10/03/2006
Last updated
06/16/2009
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