Shane Palmer Braig
Individual provider Active NPI Peer Specialist · Del City, OK
NPI 1336747609 · NPPES record last updated Oct 9, 2020
Key facts
- NPI
- 1336747609
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- Practice address
- 5113 SE 15TH St Ste a
Del City, OK 73115-3952 - Phone
- (405) 600-3252
- NPI assigned
- Oct 9, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Care for Change Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Yes |
Addresses
Primary practice location
5113 SE 15TH St Ste a
Del City, OK 73115-3952
Mailing address
100 N University Dr
Edmond, OK 73034-5207
Phone (405) 974-3632
Other practice location 1
3621 N Kelley Ave
Oklahoma City, OK 73111-4520
Phone (405) 524-5525
Other practice location 2
2305 NW 113th St
Oklahoma City, OK 73120-7302
Phone (619) 878-0445
Other providers in Del City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.