Individual
AMANDA MARIE STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
304 S PARK LN, ALTUS, OK 73521-5753
(580) 379-6500
(580) 379-6509
Mailing address
304 S PARK LN, ALTUS, OK 73521-5753
(580) 379-6500
(580) 379-6509
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2651
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200656930A
—
OK
Enumeration date
03/04/2009
Last updated
11/21/2023
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