Basic Information
| Provider Information | |||||||||
| NPI: | 1649859406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMILTON | ||||||||
| FirstName: | SHAYNA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 932 W STATE HIGHWAY 152 | ||||||||
| Address2: | |||||||||
| City: | MUSTANG | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730642301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055775477 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 932 W STATE HIGHWAY 152 | ||||||||
| Address2: | |||||||||
| City: | MUSTANG | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730642301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055775477 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2021 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | OK | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.