Healthcare Provider Details

I. General information

NPI: 1578103982
Provider Name (Legal Business Name): JULIE RENEE STOVER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 N BROADWAY ST
POTEAU OK
74953-5463
US

IV. Provider business mailing address

34124 CHOCTAW LN
POTEAU OK
74953-5261
US

V. Phone/Fax

Practice location:
  • Phone: 918-647-7416
  • Fax: 918-649-3508
Mailing address:
  • Phone: 918-635-5180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0123260
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number123422
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: