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General NPI Number Information
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NPI Number | 1942693189
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Entity Type | Individual
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Provider Name | KEISHA LYNNELL STEPHENS L.P.N.
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Gender | Female
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 1258 E 145TH PL S
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City | GLENPOOL
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State | OK
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Zip | 74033-4014
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Country | US
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Telephone | 918-497-0357
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 481083
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City | TULSA
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State | OK
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Zip | 74148-1083
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Country | US
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Telephone | 918-497-0357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | L0054917
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License Number State | OK
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