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NPI Code Detail

MEDICARE: KELLI DEAN STEPHENSON FNP-C

MEDICARE: KELLI DEAN STEPHENSON FNP-C
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
1363L00000XNurse Practitioner33371TN
2363LF0000XFamily Nurse Practitioner201394741NP-PPOR
3363LF0000XFamily Nurse PractitionerAP60494710WA
4363LX0001XObstetrics & Gynecology Nurse Practitioner201800264NP-PPOR
5367A00000XAdvanced Practice Midwife33371TN
6367A00000XAdvanced Practice Midwife201800264NP-PPOR
7363LF0000XFamily Nurse Practitioner225099OK

General Provider Information

NPI Number : 1780989772
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI DEAN STEPHENSON FNP-C
Provider Business Mailing Address
First Line : PO BOX 13620
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73113-1629
Country : US
Telephone Number : 405-445-1210
Fax Number : 405-445-3310
Provider Business Practice Location Address
First Line : 2518 N MAIN ST
Second Line :
City : MIAMI
State : OK
Zip : 74354-1602
Country : US
Telephone Number : 918-540-9077
Fax Number : 918-540-9080
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2011
Last Update Date : 08/13/2025

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