Healthcare Provider Details

I. General information

NPI: 1992930838
Provider Name (Legal Business Name): AMBER JO STOCCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER JO BAILEY

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 NW 39TH EXPY
BETHANY OK
73008-2513
US

IV. Provider business mailing address

6800 NW 39TH EXPY
BETHANY OK
73008-2513
US

V. Phone/Fax

Practice location:
  • Phone: 405-440-9866
  • Fax: 405-438-3834
Mailing address:
  • Phone: 405-440-9866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN2822
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30430
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberN2822
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number30430
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: