Active NPI
Shelby Lynn Plotkin, PA-C
- Physician Assistant
- Edmond, OK
National Provider Identifier
1104484963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 3053
- Practice address
- 4509 Integris Pkwy Ste 200
Edmond, OK 73034-8696 - Phone
- (405) 657-3895
- Fax
- (405) 657-3896
- NPI assigned
- Jun 5, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 3053 | OK | Primary |
Addresses
Primary practice location
4509 Integris Pkwy Ste 200
Edmond, OK 73034-8696
Mailing address
5300 N Independence Ave Ste 280
Oklahoma City, OK 73112-5555
Phone (405) 657-3895
Other names 1
- Shelby Lynn Nicholson
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4005 | SC | MD | Oral and Maxillofacial Pathology Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571616000000",
"number": "1104484963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 N INDEPENDENCE AVE STE 280",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731125555",
"telephone_number": "405-657-3895",
"fax_number": "405-657-3896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4509 INTEGRIS PKWY STE 200",
"city": "EDMOND",
"state": "OK",
"postal_code": "730348696",
"telephone_number": "405-657-3895",
"fax_number": "405-657-3896"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PLOTKIN",
"first_name": "SHELBY",
"middle_name": "LYNN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-05",
"last_updated": "2019-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "3053",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHELBY",
"last_name": "NICHOLSON",
"middle_name": "LYNN",
"code": "1",
"type": "Former Name"
}
]
}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 Oct 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.