Individual
STACY LUANN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
448 36TH AVE NW STE 101, NORMAN, OK 73072-4743
(405) 573-9905
Mailing address
448 36TH AVE NW STE 101, NORMAN, OK 73072-4743
(405) 573-9905
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
01/27/2022
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