Provider Demographics
NPI:1699262477
Name:FREE, SHELLEY L
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:L
Last Name:FREE
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 1:5616 E 71ST ST APT 1312
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6530
Mailing Address - Country:US
Mailing Address - Phone:918-541-0157
Mailing Address - Fax:
Practice Address - Street 1:5350 S WESTERN AVE STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4525
Practice Address - Country:US
Practice Address - Phone:405-631-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator