Provider Demographics
NPI:1952843120
Name:SHIPLEY, KELLY (AG-ACNP, FNP, CNRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:AG-ACNP, FNP, CNRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 E FRANK PHILLIPS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2411
Mailing Address - Country:US
Mailing Address - Phone:918-331-1089
Mailing Address - Fax:918-333-1823
Practice Address - Street 1:226 SE DEBELL AVE STE B
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2300
Practice Address - Country:US
Practice Address - Phone:918-331-1060
Practice Address - Fax:918-331-1065
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76809363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily