Individual
STACEY ALETHEA WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
6613 N MERIDIAN AVE, OKLAHOMA CITY, OK 73116-1423
(405) 603-8450
Mailing address
6613 N MERIDIAN AVE, OKLAHOMA CITY, OK 73116-1423
(405) 603-8450
(405) 603-8454
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0083425
OK
363LF0000X
Family Nurse Practitioner
83425
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200626780A
—
OK
Enumeration date
11/13/2015
Last updated
01/09/2019
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