Individual
JENNIFER LYN STICKELMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
505 S MAIN ST, PORTER, OK 74454-1015
(918) 483-0111
Mailing address
22272 E 730 RD, WAGONER, OK 74467-6837
(918) 694-9766
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0069196
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H081616683
DRIVERS LICENSE
OK
Enumeration date
12/03/2018
Last updated
02/13/2019
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