| Nerve Renewal Shawnee | |
|
3700 N Kickapoo Ave Ste 116 Shawnee OK 74804-0007 | |
| (405) 551-8103 | |
| (405) 669-3517 |
| Full Name | Nerve Renewal Shawnee |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 3700 N Kickapoo Ave Ste 116, Shawnee, Oklahoma |
| Authorized Official Name and Position | Timothy Coit Bales (CEO) |
| Authorized Official Contact | 4059537221 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nerve Renewal Shawnee 3705 Nw 63rd St Ste 200 Oklahoma City OK 73116-1937 Ph: (405) 953-7221 | Nerve Renewal Shawnee 3700 N Kickapoo Ave Ste 116 Shawnee OK 74804-0007 Ph: (405) 551-8103 |
| NPI Number | 1922861004 |
|---|---|
| Provider Enumeration Date | 02/01/2024 |
| Last Update Date | 03/03/2025 |
| Certification Date | 03/03/2025 |
| Medicare PECOS PAC ID | 8224476171 |
|---|---|
| Medicare Enrollment ID | O20240410004024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922861004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | () | Primary |
| Provider Name | Alexa G Woodson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720082266 PECOS PAC ID: 6103853460 Enrollment ID: I20050719000855 |
| Provider Name | Lauren Michele Rubino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013109297 PECOS PAC ID: 6204015571 Enrollment ID: I20110119001090 |
| Provider Name | Kathleen Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861027682 PECOS PAC ID: 1456777358 Enrollment ID: I20200821000882 |
| Provider Name | Marlana Marie Travis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487238531 PECOS PAC ID: 0941601256 Enrollment ID: I20210624000741 |
| Provider Name | Latrica Louise Dorsey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538696083 PECOS PAC ID: 1658777024 Enrollment ID: I20210909003063 |
| Provider Name | Thingal G Masar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417600099 PECOS PAC ID: 3274980107 Enrollment ID: I20231114001379 |
| Provider Name | Deesha Brooke Lornes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023971553 PECOS PAC ID: 1153806633 Enrollment ID: I20260402000512 |
Team Clinics Ah LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 800 N Louisa Ave, Shawnee, OK 74801 Phone: 405-273-1846 |
Team Clinics Ah LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1111 N Kennedy Ave Ste B, Shawnee, OK 74801 Phone: 405-600-6869 |
Oklahoma Baptist University Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 W University St, Shawnee, OK 74804 Phone: 405-878-2153 |
SSM Health Medical Group Shawnee Kickapoo Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3700 N Kickapoo Ave, Shawnee, OK 74804 Phone: 405-273-6383 Fax: 405-273-3748 |
Team Clinics Ah LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 326 N Union Ave, Shawnee, OK 74801 Phone: 405-600-6869 |
Team Clinics Ah LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1401 E Independence St, Shawnee, OK 74804 Phone: 405-600-6869 |