Healthcare Provider Details

I. General information

NPI: 1316178262
Provider Name (Legal Business Name): STEPHANIE RANAE MOWDY APRN,MS,CCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE RANAE MOWDY APRN,MS,CCNS

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 COLONY DR
ADA OK
74820-2329
US

IV. Provider business mailing address

527 W 3RD ST
KONAWA OK
74849-1415
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-5111
  • Fax: 580-436-1159
Mailing address:
  • Phone: 580-925-3286
  • Fax: 580-925-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR47989
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberR0047989
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License NumberR47989
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR47989
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: