Provider Demographics
NPI:1689266934
Name:SHELBY, COURNEY RAELLEN
Entity Type:Individual
Prefix:
First Name:COURNEY
Middle Name:RAELLEN
Last Name:SHELBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:RAELLEN
Other - Last Name:LINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1342 N 155TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74116-2449
Mailing Address - Country:US
Mailing Address - Phone:918-549-0256
Mailing Address - Fax:
Practice Address - Street 1:1342 N 155TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74116-2449
Practice Address - Country:US
Practice Address - Phone:918-549-0256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator