MEDICARE: DR. TIMMENI LYNN STEVENS D.O.

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	207V00000X	Obstetrics & Gynecology Physician	5380	OK

General Provider Information

NPI Number	:	1740545722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMMENI LYNN STEVENS D.O.

Provider Business Mailing Address
First Line	:	701 E MAIN ST
Second Line	:
City	:	JENKS
State	:	OK
Zip	:	74037-4316
Country	:	US
Telephone Number	:	918-298-2603
Fax Number	:

Provider Business Practice Location Address
First Line	:	8803 S 101ST EAST AVE STE 245
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5730
Country	:	US
Telephone Number	:	918-858-0008
Fax Number	:	918-858-0074

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

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	08/03/2022

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