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NPI Code Detail

MEDICARE: MRS. STACEY LYNN LOWERY NURSE PRACTITIONER

MEDICARE: MRS. STACEY LYNN LOWERY NURSE PRACTITIONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner85025OK

General Provider Information

NPI Number : 1528608551
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACEY LYNN LOWERY NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 1006 NE 17TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73111-1002
Country : US
Telephone Number : 405-419-9800
Fax Number : 405-521-8496
Provider Business Practice Location Address
First Line : 1006 NE 17TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73111-1002
Country : US
Telephone Number : 405-419-9800
Fax Number : 405-521-8496
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2020
Last Update Date : 12/01/2022

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