Provider Demographics
NPI:1205366705
Name:GRAY, SHANNON ANN (BHCM I)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ANN
Last Name:GRAY
Suffix:
Gender:F
Credentials:BHCM I
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:ANN
Other - Last Name:CHAPLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6104 E 128TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2742
Mailing Address - Country:US
Mailing Address - Phone:918-955-2030
Mailing Address - Fax:
Practice Address - Street 1:2227 S GARNETT RD STE 109
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5115
Practice Address - Country:US
Practice Address - Phone:918-470-9605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK311695171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator