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NPI Code Detail

MEDICARE: STACY S. BROWN PA-C

MEDICARE: STACY S. BROWN PA-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
1363A00000XPhysician Assistant1182OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00878500OTHEROKMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841274099
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY S. BROWN PA-C
Provider Business Mailing Address
First Line : 14024 QUAIL POINTE DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-1006
Country : US
Telephone Number : 405-419-8465
Fax Number : 405-419-7745
Provider Business Practice Location Address
First Line : 3115 SW 89TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-7901
Country : US
Telephone Number : 405-427-3705
Fax Number : 405-427-3738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 07/14/2021

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