Provider Demographics
NPI:1245971522
Name:SHEELEY, PATTI V
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:V
Last Name:SHEELEY
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 1:405 E KINDER WELLS BLVD
Mailing Address - Street 2:
Mailing Address - City:PERKINS
Mailing Address - State:OK
Mailing Address - Zip Code:74059-4510
Mailing Address - Country:US
Mailing Address - Phone:719-200-7425
Mailing Address - Fax:
Practice Address - Street 1:405 E KINDER WELLS BLVD
Practice Address - Street 2:
Practice Address - City:PERKINS
Practice Address - State:OK
Practice Address - Zip Code:74059-4510
Practice Address - Country:US
Practice Address - Phone:719-200-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0052175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0052OtherOFFICE OF LICENSURE AND CERTIFICATION BOARD OF NATUROPATHIC EXAMINERS