Healthcare Provider Details

I. General information

NPI: 1437547288
Provider Name (Legal Business Name): STEPHANIE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W 13TH ST
GROVE OK
74344-3224
US

IV. Provider business mailing address

115 W 13TH ST
GROVE OK
74344-3224
US

V. Phone/Fax

Practice location:
  • Phone: 417-624-0440
  • Fax: 417-624-9652
Mailing address:
  • Phone: 417-624-0440
  • Fax: 417-624-9652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number215866
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: