MEDICARE: STEPHANIE M ROSEKELLY CNM, APN

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	367A00000X	Advanced Practice Midwife	R0135299	OK

General Provider Information

NPI Number	:	1427338102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE M ROSEKELLY CNM, APN

Provider Business Mailing Address
First Line	:	4086 COUNTRY CLUB RD STE 2
Second Line	:
City	:	DUNCAN
State	:	OK
Zip	:	73533-5580
Country	:	US
Telephone Number	:	847-989-9124
Fax Number	:	214-617-0352

Provider Business Practice Location Address
First Line	:	4086 COUNTRY CLUB RD STE 2
Second Line	:
City	:	DUNCAN
State	:	OK
Zip	:	73533-5580
Country	:	US
Telephone Number	:	580-609-0105
Fax Number	:	214-617-0352

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

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	09/06/2023

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