Healthcare Provider Details

I. General information

NPI: 1245153139
Provider Name (Legal Business Name): MARY SHYCOTTA RENEE STONEHOCKER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N CENTRAL AVE
CARMEN OK
73726-2403
US

IV. Provider business mailing address

510 N CENTRAL AVE
CARMEN OK
73726-2403
US

V. Phone/Fax

Practice location:
  • Phone: 580-596-8020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202260
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: