Healthcare Provider Details

I. General information

NPI: 1528793478
Provider Name (Legal Business Name): STELLAR, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 03/07/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MAGNOLIA COURT STE 101
MOORE OK
73160
US

IV. Provider business mailing address

PO BOX 720686
NORMAN OK
73070-4522
US

V. Phone/Fax

Practice location:
  • Phone: 405-857-7681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LOWRY
Title or Position: APRN, OWNER
Credential: APRN
Phone: 405-857-7681