Individual
MS. SHELLY ANN BOSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
216 S 7TH ST, SUITE 1, VINITA, OK 74301-3742
(918) 256-1501
(918) 323-0460
Mailing address
216 SOUTH 7TH STREET, SUITE 1, VINITA, OK 74301-3720
(918) 256-1501
(918) 323-0460
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
78693
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200390480A
—
OK
01
—
200509690H
GROUP MEDICAID
OK
Enumeration date
07/25/2011
Last updated
11/20/2014
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