Angela Renee Short

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

311698 Issued in OK

Practice address

2121 S 125TH East Ave Ste 106
Tulsa, OK 74129-5800

Phone

(918) 574-8442

Fax

(918) 591-3955

NPI assigned

Jun 20, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Angela Renee Shepherd 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": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1811417934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23110 E 67TH ST S",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740142103",
            "telephone_number": "918-630-4663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 S 125TH EAST AVE STE 106",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741295800",
            "telephone_number": "918-574-8442",
            "fax_number": "918-591-3955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORT",
        "first_name": "ANGELA",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-20",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "OK",
            "license": "311698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "SHEPHERD",
            "middle_name": "RENEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karen Shomaker, P.T.
• Jessica Shook, APRN-CNS, ACCNS-AG
• Krystal Dawn Shook, APRN-BC
• Joseph Brian Shoop, DDS
• Robin R Shope, CERT SURGICAL TECH
• Belinda Short
• Jimmy Short
• Latanya Short
• Lou Ann Short, COTA
• Megan Short, AUD

• Mental Health Clinic/Center (Including Community Mental Health Center) in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.

Verify at the official NPI Registry.