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NPI Code Detail

MEDICARE: STACEY LYNN LOSSON

MEDICARE: STACEY LYNN LOSSON
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1346923653
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY LYNN LOSSON
Provider Business Mailing Address
First Line : 1076 W MAPLE AVE
Second Line :
City : DUNCAN
State : OK
Zip : 73533-4787
Country : US
Telephone Number : 580-606-6719
Fax Number :
Provider Business Practice Location Address
First Line : 1076 W MAPLE AVE
Second Line :
City : DUNCAN
State : OK
Zip : 73533-4787
Country : US
Telephone Number : 580-606-6719
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2023
Last Update Date : 08/11/2023

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Directions to “ STACEY LYNN LOSSON ” Practice Location

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