Healthcare Provider Details

I. General information

NPI: 1417412362
Provider Name (Legal Business Name): STEPHANIE JUSTUS APRN-CNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 W WILL ROGERS BLVD
CLAREMORE OK
74017-5421
US

IV. Provider business mailing address

1124 W WILL ROGERS BLVD
CLAREMORE OK
74017-5421
US

V. Phone/Fax

Practice location:
  • Phone: 918-322-7400
  • Fax: 918-322-7600
Mailing address:
  • Phone: 918-322-7400
  • Fax: 918-322-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0132543
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: