Shannon Reavis, ARNP FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F04190051 Issued in OK

Practice address

21625 E 460 Rd
Claremore, OK 74019-2876

Phone

(918) 606-5702

NPI assigned

Jan 7, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Shannon Cooper Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1073153029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35904 S HIGHWAY 82",
            "city": "VINITA",
            "state": "OK",
            "postal_code": "743016743",
            "telephone_number": "918-782-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21625 E 460 RD",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740192876",
            "telephone_number": "918-606-5702"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "35904 S Highway 82",
            "address_purpose": "LOCATION",
            "city": "Vinita",
            "state": "OK",
            "postal_code": "743016743",
            "country_code": "US",
            "telephone_number": "918-782-1414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REAVIS",
        "first_name": "SHANNON",
        "name_prefix": "Mrs.",
        "credential": "ARNP FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "F04190051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "COOPER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hailey Nichole Ratley, COTA/L
• Shelby Rauh, DO
• Alisa Lou Ray, RN
• Natasha Jean Ray
• RBS Evolution of Oklahoma LLC (Northeastern Oklahoma Cancer Inst)
• Rebecca Wright DO PLLC
• Chantel Renee Reben
• Aleiya Marie Record
• Red Hawk Behavioral Health LLC (Red Hawk Behavioral Health)
• Suzanne Redden

• Family Nurse Practitioner in Claremore, OK
• Providers in Claremore, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.