Provider Demographics
NPI:1386947570
Name:BIERIG, SHANNON LEE (APRN-CNP, CNS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:BIERIG
Suffix:
Gender:F
Credentials:APRN-CNP, CNS
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEE
Other - Last Name:BIERIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, APN, CCNS
Mailing Address - Street 1:604 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4222
Mailing Address - Country:US
Mailing Address - Phone:888-990-4279
Mailing Address - Fax:
Practice Address - Street 1:275 S PERKINS RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3665
Practice Address - Country:US
Practice Address - Phone:405-334-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59027364SA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200330130AMedicaid
OK200330130AMedicaid