STACY DANIELLE PROVENCE NPI 1912376765

NPI Information

NPI: 1912376765
Provider Name: STACY DANIELLE PROVENCE
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Individual

Specialization: Pediatrics

Address:
6800 NW 39TH EXPY
BETHANY, OK
ZIP 73008
Phone: (405) 789-6711
Get Directions

Stacy Danielle Provence is a pediatrics nurse practitioner in Bethany, OK. Stacy Danielle Provence NPI is 1912376765. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

6800 NW 39TH EXPY
BETHANY, OK
ZIP 73008-513
Phone: (405) 789-6711
Fax: (405) 440-6716

The enumeration date for this NPI number is 9/23/2015 and was last updated on 11/14/2019.

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
1	363LP0200X	Nurse Practitioner	Pediatrics	0089753	OKLAHOMA	Yes

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: 5/5/2024

NPI Synchronization or Removal

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