Provider Demographics
NPI:1477734697
Name:SHELTON, STEPHANIE CELINE (ARNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CELINE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:DODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 141; ATTN: TERRI
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-936-5800
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:701 N PRESTON RD STE 100
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3748
Practice Address - Country:US
Practice Address - Phone:972-382-1000
Practice Address - Fax:972-382-1167
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0075398363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK36034OtherOBNDD
TX715892OtherLICENSE
OKR0075398OtherLICENSE