Provider Demographics
NPI:1205250461
Name:WALES, ALEASHA
Entity type:Individual
Prefix:
First Name:ALEASHA
Middle Name:
Last Name:WALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEASHA
Other - Middle Name:
Other - Last Name:SHELNUTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9024 BUTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-9111
Mailing Address - Country:US
Mailing Address - Phone:405-412-6993
Mailing Address - Fax:
Practice Address - Street 1:9024 BUTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-9111
Practice Address - Country:US
Practice Address - Phone:405-412-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-08
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator