Healthcare Provider Details

I. General information

NPI: 1104212448
Provider Name (Legal Business Name): STACEY CULLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EVERETT DR FL 7
OKLAHOMA CITY OK
73104-5047
US

IV. Provider business mailing address

3533 S ALAMEDA ST
CORPUS CHRISTI TX
78411-1721
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5215
  • Fax: 405-271-1236
Mailing address:
  • Phone: 361-694-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAP127965
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP127965
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number218198
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: