Active NPI
Shakila Kashawn Green, CMII
- Addiction (Substance Use Disorder) Counselor
- Konawa, OK
National Provider Identifier
1336669795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 14430 NS 3500
Konawa, OK 74849-4901 - Phone
- (580) 925-2650
- NPI assigned
- Jun 26, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
14430 NS 3500
Konawa, OK 74849-4901
Mailing address
14430 NS 3500
Konawa, OK 74849-4901
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200724510A | Medicaid | OK | |
| 200128860A | Medicaid | OK |
Other names 1
- Shakila Kashawn Sorrells
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valliant House, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Substance Abuse Rehabilitation Facility
- Valliant, OK
- NPI 1104030402
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639094400000",
"number": "1336669795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14430 NS 3500",
"city": "KONAWA",
"state": "OK",
"postal_code": "748494901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14430 NS 3500",
"city": "KONAWA",
"state": "OK",
"postal_code": "748494901",
"telephone_number": "580-925-2650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "SHAKILA",
"middle_name": "KASHAWN",
"credential": "CMII",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-26",
"last_updated": "2021-12-10",
"certification_date": "2021-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200724510A",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200128860A",
"state": "OK"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHAKILA",
"last_name": "SORRELLS",
"middle_name": "KASHAWN",
"credential": "CMII",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Konawa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.