Provider Demographics
NPI:1497594964
Name:ROSSON, SHELBY JO
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:JO
Last Name:ROSSON
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 1:14022 S 209TH W AVE
Mailing Address - Street 2:
Mailing Address - City:KELLYVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74039
Mailing Address - Country:US
Mailing Address - Phone:918-316-9832
Mailing Address - Fax:
Practice Address - Street 1:2325 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114
Practice Address - Country:US
Practice Address - Phone:918-712-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator