Individual
ANITA STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S
Contact information
Practice address
235 E. GRAHAM, PRYOR, OK 74361-2436
(918) 825-1405
(918) 825-1406
Mailing address
231 E GRAHAM AVE, PRYOR, OK 74361-2436
(918) 825-1405
(918) 825-1406
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/22/2014
Last updated
11/02/2015
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