MEDICARE: MRS. STEPHANIE LYNN CAUGHMAN CPNP

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	363LP0200X	Pediatric Nurse Practitioner	R0050189	OK

General Provider Information

NPI Number	:	1366493975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE LYNN CAUGHMAN CPNP

Provider Business Mailing Address
First Line	:	9353 S 282ND EAST AVE
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-5760
Country	:	US
Telephone Number	:	918-486-4355
Fax Number	:	918-254-6823

Provider Business Practice Location Address
First Line	:	9228 S MINGO RD
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5721
Country	:	US
Telephone Number	:	918-254-6822
Fax Number	:	918-254-6823

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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