Individual
STEPHANIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
8115 S MEMORIAL DR, TULSA, OK 74133-4331
(918) 254-6315
(918) 403-6315
Mailing address
3805 S DOGWOOD BLVD, BROKEN ARROW, OK 74011-1769
(918) 724-4563
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
932
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100740390A
—
OK
Enumeration date
03/24/2006
Last updated
01/13/2026
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