Provider Demographics
NPI:1679115703
Name:JOHN, SHYMOL A (APRN, CNP)
Entity type:Individual
Prefix:
First Name:SHYMOL
Middle Name:A
Last Name:JOHN
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SW 80TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9405
Mailing Address - Country:US
Mailing Address - Phone:405-601-8980
Mailing Address - Fax:405-631-9025
Practice Address - Street 1:525 SW 80TH ST
Practice Address - Street 2:STE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9405
Practice Address - Country:US
Practice Address - Phone:405-631-0481
Practice Address - Fax:405-631-9025
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily