Individual
STACY LUANN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2821 N VAN BUREN ST, ENID, OK 73703-1729
(580) 616-6340
(580) 616-3644
Mailing address
3001 QUAIL SPRINGS PKWY FL 5, OKLAHOMA CITY, OK 73134-2640
(580) 616-6340
(580) 616-3644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-01282
KS
363A00000X
Physician Assistant
Primary
1724
OK
Other
Enumeration date
02/06/2008
Last updated
07/28/2026
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