Provider Demographics
NPI:1972940708
Name:LANG-SHEPPARD, KELLY (APRN-CNS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LANG-SHEPPARD
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-945-4700
Mailing Address - Fax:405-945-4270
Practice Address - Street 1:5401 N PORTLAND AVE STE 410
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2131
Practice Address - Country:US
Practice Address - Phone:405-945-4700
Practice Address - Fax:405-945-4270
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60786364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist