MEDICARE: STACEY D KNAPP DO PC INC

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	207Q00000X	Family Medicine Physician	20-1347913	OK

General Provider Information

NPI Number	:	1689675688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STACEY D KNAPP DO PC INC

Provider Business Mailing Address
First Line	:	209 S 30TH ST
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-3100
Country	:	US
Telephone Number	:	580-323-7800
Fax Number	:	580-323-7803

Provider Business Practice Location Address
First Line	:	209 S 30TH ST
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-3100
Country	:	US
Telephone Number	:	580-323-7800
Fax Number	:	580-323-7803

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	STACEY D KNAPP
Credential	:	DO
Telephone Number	:	580-323-7800

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	08/15/2011

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