Individual
SHANNA PERETTA THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FSP
Contact information
Practice address
107 S HIGH ST, ANTLERS, OK 74523-3818
(580) 298-2830
(580) 298-6723
Mailing address
107 S HIGH ST, ANTLERS, OK 74523-3818
(580) 298-2830
(580) 298-6723
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
OK
Other
Enumeration date
12/11/2017
Last updated
12/11/2017
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