Healthcare Provider Details

I. General information

NPI: 1225962137
Provider Name (Legal Business Name): KATHRYN JADE STALLINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 COLONY DR
ADA OK
74820-2297
US

IV. Provider business mailing address

710 COLONY DR
ADA OK
74820-2297
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-7206
  • Fax: 580-272-5757
Mailing address:
  • Phone: 580-436-7206
  • Fax: 580-272-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number21881
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: