Individual
KENDRA K STACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
102 NW 31ST, LAWTON, OK 73505
(580) 353-6790
(580) 510-7019
Mailing address
PO BOX 785, LAWTON, OK 73502
(580) 357-9984
(580) 357-3277
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0052337
OK
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
R0052337
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
628427054001
BCBS-FREDERICK
OK
01
—
7591256
AETNA
OK
Enumeration date
09/20/2005
Last updated
02/12/2008
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