Provider Demographics
NPI:1265049654
Name:PRESLEY, SHAYLA RICCHELE (BHA)
Entity type:Individual
Prefix:MRS
First Name:SHAYLA
Middle Name:RICCHELE
Last Name:PRESLEY
Suffix:
Gender:F
Credentials:BHA
Other - Prefix:MRS
Other - First Name:SHAYLA
Other - Middle Name:RICCHELE
Other - Last Name:PRESLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3036 S 214TH ST W
Mailing Address - Street 2:
Mailing Address - City:BOYNTON
Mailing Address - State:OK
Mailing Address - Zip Code:74422-5103
Mailing Address - Country:US
Mailing Address - Phone:539-286-9624
Mailing Address - Fax:
Practice Address - Street 1:109 S HARRILL AVE
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-5317
Practice Address - Country:US
Practice Address - Phone:918-485-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)