Provider Demographics
NPI:1427439140
Name:SHIVERS, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SHIVERS
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 1:1304 W MCALESTER AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-5448
Mailing Address - Country:US
Mailing Address - Phone:405-264-6121
Mailing Address - Fax:
Practice Address - Street 1:1304 W MCALESTER AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-5448
Practice Address - Country:US
Practice Address - Phone:405-264-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator