Provider Demographics
NPI:1710274592
Name:SHELL, JESSICA ERIN (RRT-NPS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:SHELL
Suffix:
Gender:F
Credentials:RRT-NPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-4417
Mailing Address - Country:US
Mailing Address - Phone:405-503-7017
Mailing Address - Fax:
Practice Address - Street 1:1200 N PHILLIPS AVE STE 9100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26372278P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Function Technologist