Provider Demographics
NPI:1083169403
Name:SCHOONOVER, SHELLY (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:SCHOONOVER
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-0751
Mailing Address - Country:US
Mailing Address - Phone:918-772-3390
Mailing Address - Fax:
Practice Address - Street 1:1328 S YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-7650
Practice Address - Country:US
Practice Address - Phone:918-683-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK68346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily