Provider Demographics
NPI:1003363250
Name:ADAMS, HARVEY SHANE (APRN)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:SHANE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12112 GREENLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4842
Mailing Address - Country:US
Mailing Address - Phone:405-823-5302
Mailing Address - Fax:
Practice Address - Street 1:12112 GREENLAWN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-4842
Practice Address - Country:US
Practice Address - Phone:405-823-5302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0077957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily