Provider Demographics
NPI:1760165237
Name:WOOTEN, SHIELA
Entity Type:Individual
Prefix:
First Name:SHIELA
Middle Name:
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHIELA
Other - Middle Name:
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:BRAGGS
Mailing Address - State:OK
Mailing Address - Zip Code:74423-0194
Mailing Address - Country:US
Mailing Address - Phone:918-471-5485
Mailing Address - Fax:
Practice Address - Street 1:12022 GREENLEAF RD
Practice Address - Street 2:
Practice Address - City:BRAGGS
Practice Address - State:OK
Practice Address - Zip Code:74423-5136
Practice Address - Country:US
Practice Address - Phone:918-471-5485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management