Healthcare Provider Details

I. General information

NPI: 1417153776
Provider Name (Legal Business Name): PATRICIA ANN JUSTICE STEVENSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA ANN JUSTICE RN

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 11/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11770 RODEO DR
SKIATOOK OK
74070-5804
US

IV. Provider business mailing address

11770 RODEO DR
SKIATOOK OK
74070-5804
US

V. Phone/Fax

Practice location:
  • Phone: 405-473-2123
  • Fax:
Mailing address:
  • Phone: 405-473-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number43974
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number2017
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: