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SHELLEY WAGGONER
NPI 1417299447
Specialist in Tulsa, OK

Active since March 16, 2013PECOS EnrolledAccepts Medicare Assignment
6333 E SKELLY DR, TULSA, OK 74135(918) 633-2442 Get Directions Write a Review

NPPES record last updated: March 16, 2013. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Shelley Waggoner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHELLEY WAGGONER (NPI 1417299447) is an individual specialist in Tulsa, Oklahoma and active in the NPI registry since March 2013. She is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1417299447
Entity TypeIndividualFemale
Primary Taxonomy174400000X
Provider Legal NameSHELLEY WAGGONER
Location Address6333 E SKELLY DRTulsa, OK 74135-6106
Mailing Address6727 S 73rd East AveTulsa, OK 74133-1832 · (918) 734-5866
Phone(918) 633-2442
Sole ProprietorYes
Medical School CMSOtherGraduated 2019
Enumeration DateMarch 16, 2013
✔ NPI 1417299447 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
6333 E SKELLY DR, Tulsa, OK 74135
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Oklahoma, Oscar Insurance Company.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shelley Waggoner is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8123468949
PECOS Enrollment IDI20240426002186
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Shelley Waggoner reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Grand Lake Mental Health Center Inc
Same address
Mental Health (Including Community Mental Health Center)
6333 E SKELLY DR
Tulsa, OK 74135
  • Reassigned Medicare billing, Oklahoma enrollment
  • 333 clinicians in this Medicare group
NPI 1588136758 (918) 273-1841

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JERRY LEE MANUS
Case Manager/Care Coordinator
6333 E SKELLY DR
TULSA, OK 74135
Tulsa County (918) 664-4224
KRYSTAL DAWN HUTCHINSON
Peer Specialist
6333 E SKELLY DR
TULSA, OK 74135
Tulsa County (918) 779-7216
MS. ABIGAIL ELIZABETH CARLISLE
Case Manager/Care Coordinator
6333 E SKELLY DR
TULSA, OK 74135
Tulsa County (000) 000-0000
TANYA CRAWFORD RN
Registered Nurse
6333 E SKELLY DR
TULSA, OK 74135
Tulsa County (918) 664-4224
KELLI ANN ORDORICA
Case Manager/Care Coordinator
6333 E SKELLY DR
TULSA, OK 74135
Tulsa County (918) 779-7151
JAYSON SWISHER
Peer Specialist
6333 E SKELLY DR
TULSA, OK 74135
Tulsa County (918) 664-4224
IVAN HONEYCUTT
Peer Specialist
6333 E SKELLY DR
TULSA, OK 74135
Tulsa County (918) 222-2222
GLORY S KALAKURCHA M.A.
Counselor (Addiction (Substance Use Disorder))
6333 E SKELLY DR
TULSA, OK 74135
Tulsa County (918) 664-4224

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shelley Waggoner's NPI number?

The NPI number for Shelley Waggoner is 1417299447. It was assigned to this individual provider in the NPPES registry on March 16, 2013.

Where is Shelley Waggoner located?

Shelley Waggoner practices at 6333 E Skelly Dr, Tulsa, OK 74135. The listed phone number is (918) 633-2442.

What is Shelley Waggoner's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Shelley Waggoner enrolled in Medicare?

Yes. Shelley Waggoner is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Shelley Waggoner's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shelley Waggoner reassigns Medicare benefits to Grand Lake Mental Health Center Inc (Tulsa, OK). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shelley Waggoner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Shelley Waggoner accept?

Health plans from Blue Cross and Blue Shield of Oklahoma and Oscar Insurance Company list Shelley Waggoner as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shelley Waggoner was last updated on March 16, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.