Provider Demographics
NPI:1023251360
Name:SHELTON, TAUSHA ZANN (ARNP-CNP)
Entity type:Individual
Prefix:
First Name:TAUSHA
Middle Name:ZANN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:ARNP-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:731 12TH AVE NW
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5761
Mailing Address - Country:US
Mailing Address - Phone:580-224-9000
Mailing Address - Fax:580-224-9009
Practice Address - Street 1:1116 WALNUT DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2353
Practice Address - Country:US
Practice Address - Phone:580-226-0543
Practice Address - Fax:580-226-2284
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0054948363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200237680AMedicaid