Provider Demographics
NPI:1386377000
Name:RAUH, SHELLEY LARAE (APRN)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LARAE
Last Name:RAUH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 QUAIL SPRINGS PKWY FL 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2640
Mailing Address - Country:US
Mailing Address - Phone:405-853-6100
Mailing Address - Fax:405-853-4491
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HENNESSEY
Practice Address - State:OK
Practice Address - Zip Code:73742-1019
Practice Address - Country:US
Practice Address - Phone:405-853-6100
Practice Address - Fax:405-853-4491
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK209030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily