Provider Demographics
NPI:1497336861
Name:CUNNINGHAM, SHELBY M
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:M
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 COUNTY STREET 2750
Mailing Address - Street 2:
Mailing Address - City:VERDEN
Mailing Address - State:OK
Mailing Address - Zip Code:73092-8314
Mailing Address - Country:US
Mailing Address - Phone:405-574-4678
Mailing Address - Fax:
Practice Address - Street 1:2088 N HWY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1416
Practice Address - Country:US
Practice Address - Phone:580-606-6201
Practice Address - Fax:580-786-3200
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily