Provider Demographics
NPI:1316319817
Name:STEPHENS, SHELBY RAE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:RAE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10251 STONE GATE DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:OK
Mailing Address - Zip Code:73007-7520
Mailing Address - Country:US
Mailing Address - Phone:405-323-4198
Mailing Address - Fax:
Practice Address - Street 1:65 S SAINTS BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3051
Practice Address - Country:US
Practice Address - Phone:405-285-5304
Practice Address - Fax:405-285-5305
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2542363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical