MEDICARE: OKLAHOMA ADVANCED PRACTICE FAMILY NURSING, PLLC

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
1	363LF0000X	Family Nurse Practitioner	R0058331	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174975023	OTHER	OK	NPPES

General Provider Information

NPI Number	:	1689120289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA ADVANCED PRACTICE FAMILY NURSING, PLLC

Provider Business Mailing Address
First Line	:	220 SW 89TH ST STE D
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-8517
Country	:	US
Telephone Number	:	405-839-8005
Fax Number	:	833-733-0704

Provider Business Practice Location Address
First Line	:	10300 GREENBRIAR PKWY STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7671
Country	:	US
Telephone Number	:	405-839-8005
Fax Number	:	833-733-0704

Authorized Official
Title or Position	:	MEMBER
Name	:	MICHELLE RENEE STEPHENS
Credential	:	APRN
Telephone Number	:	405-821-7008

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	06/08/2026

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