Active NPI
Tra'Vant'E Keagon Shaw
- Behavior Technician
- Edmond, OK
National Provider Identifier
1043048986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 1165994
- Practice address
- 401 S Coltrane Rd Ste 260
Edmond, OK 73034-6722 - Phone
- (405) 465-6607
- NPI assigned
- Jul 23, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 1165994 | OK | Primary |
Addresses
Primary practice location
401 S Coltrane Rd Ste 260
Edmond, OK 73034-6722
Mailing address
301 W Davis Ave Apt 15
Weatherford, OK 73096-3016
Phone (580) 279-7852
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1165994 | OK | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721692800000",
"number": "1043048986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 W DAVIS AVE APT 15",
"city": "WEATHERFORD",
"state": "OK",
"postal_code": "730963016",
"telephone_number": "580-279-7852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 S COLTRANE RD STE 260",
"city": "EDMOND",
"state": "OK",
"postal_code": "730346722",
"telephone_number": "405-465-6607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "TRA'VANT'E",
"middle_name": "KEAGON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-23",
"last_updated": "2024-07-23",
"certification_date": "2024-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "OK",
"license": "1165994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.