Healthcare Provider Details

I. General information

NPI: 1679371983
Provider Name (Legal Business Name): STACIA KAYLEE HOMAN APRN, PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 13TH ST
GROVE OK
74344-2989
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-9009
  • Fax: 918-786-3724
Mailing address:
  • Phone: 918-786-9009
  • Fax: 918-786-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number222271
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: