Healthcare Provider Details

I. General information

NPI: 1497484083
Provider Name (Legal Business Name): STEPHANIE WRIGHTSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 E SKELLY DR
TULSA OK
74135-6106
US

IV. Provider business mailing address

6333 E SKELLY DR
TULSA OK
74135-6106
US

V. Phone/Fax

Practice location:
  • Phone: 918-779-7216
  • Fax: 918-663-0203
Mailing address:
  • Phone: 918-779-7216
  • Fax: 918-663-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number93125
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: