Healthcare Provider Details

I. General information

NPI: 1144464256
Provider Name (Legal Business Name): STEPHANIE ALISHA BATT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ALISHA SAWYER

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E JOSEPHINE AVE
FREDERICK OK
73542-2220
US

IV. Provider business mailing address

PO BOX 785
LAWTON OK
73502-0785
US

V. Phone/Fax

Practice location:
  • Phone: 580-335-7545
  • Fax: 580-335-7619
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1820
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: