MEDICARE: MRS. TALESHA ANN STEPHENS BSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OK

General Provider Information

NPI Number	:	1093072704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TALESHA ANN STEPHENS BSW

Provider Business Mailing Address
First Line	:	650 S PEORIA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-4429
Country	:	US
Telephone Number	:	918-587-9471
Fax Number	:	918-560-1399

Provider Business Practice Location Address
First Line	:	3511 MEADOWBROOK DR
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-7928
Country	:	US
Telephone Number	:	918-967-8491
Fax Number	:	189-967-2552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	01/15/2019

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