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General NPI Number Information
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NPI Number | 1528793478
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Entity Type | Organization
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Legal Business Name | STELLAR, PLLC
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1201 MAGNOLIA COURT STE 101
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City | MOORE
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State | OK
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Zip | 73160
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Country | US
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Telephone | 405-857-7681
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 720686
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City | NORMAN
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State | OK
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Zip | 73070-4522
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | APRN, OWNER
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Name | AMANDA LOWRY
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Credential | APRN
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Telephone | 405-857-7681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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