Provider Demographics
NPI:1811586969
Name:BILLY, SHELBY
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:BILLY
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 1:26661 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:OK
Mailing Address - Zip Code:74932-2458
Mailing Address - Country:US
Mailing Address - Phone:918-647-3225
Mailing Address - Fax:
Practice Address - Street 1:26661 W 5TH ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:OK
Practice Address - Zip Code:74932-2458
Practice Address - Country:US
Practice Address - Phone:918-654-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR201106235Z00000X
OK4545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist