Healthcare Provider Details

I. General information

NPI: 1497364699
Provider Name (Legal Business Name): STACIE JENELLE HANES APRN-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 W MEMORIAL RD FL 3
OKLAHOMA CITY OK
73120-8358
US

IV. Provider business mailing address

7800 NW 85TH TER
OKLAHOMA CITY OK
73132-3385
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-1283
  • Fax: 405-608-3665
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberR0062625
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: