CHANCE RAY SHADWICK NPI 1164120549

NPI Information

  • NPI: 1164120549
  • Provider Name: CHANCE RAY SHADWICK
  • Classification: Peer Specialist - 175T00000X
  • Entity Type: Individual
  • Address: 405 E EXCELSIOR AVE
    VINITA, OK
    ZIP 74301
  • Phone: (918) 864-0706

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NPI Details

Chance Ray Shadwick is a peer specialist in Vinita, OK. The provider is individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. Chance Ray Shadwick NPI is 1164120549. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

405 E EXCELSIOR AVE
VINITA, OK
ZIP 74301-226
Phone: (918) 864-0706

The enumeration date for this NPI number is 2/15/2023 and was last updated on 2/15/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1175T00000XPeer SpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11710994835MEDICAIDOKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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