Healthcare Provider Details

I. General information

NPI: 1194636811
Provider Name (Legal Business Name): MRS. CAMI MARIE BOWMAN-STICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16312 E 102ND ST N
OWASSO OK
74055-4009
US

IV. Provider business mailing address

16312 E 102ND ST N
OWASSO OK
74055-4009
US

V. Phone/Fax

Practice location:
  • Phone: 918-348-8818
  • Fax:
Mailing address:
  • Phone: 918-348-8818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0133583
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: