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NPI Code Detail

MEDICARE: STEPHANIE RUSSELL P.A.

MEDICARE: STEPHANIE RUSSELL P.A.
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
1363AM0700XMedical Physician Assistant932OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235199118
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE RUSSELL P.A.
Provider Business Mailing Address
First Line : 3805 S DOGWOOD BLVD
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74011-1769
Country : US
Telephone Number : 918-724-4563
Fax Number :
Provider Business Practice Location Address
First Line : 8115 S MEMORIAL DR
Second Line :
City : TULSA
State : OK
Zip : 74133-4331
Country : US
Telephone Number : 918-254-6315
Fax Number : 918-403-6315
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 01/13/2026

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Directions to “ STEPHANIE RUSSELL P.A.” Practice Location

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