MEDICARE: STEPHANIE DAWN ANDERSON APRN-CNP

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	363LF0000X	Family Nurse Practitioner	99387	OK

General Provider Information

NPI Number	:	1457820870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DAWN ANDERSON APRN-CNP

Provider Business Mailing Address
First Line	:	11810 S COUNCIL RD
Second Line	:
City	:	CASHION
State	:	OK
Zip	:	73016-9627
Country	:	US
Telephone Number	:	140-548-8423
Fax Number	:

Provider Business Practice Location Address
First Line	:	12220 N MACARTHUR BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1850
Country	:	US
Telephone Number	:	405-437-1100
Fax Number	:

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

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	07/28/2024

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